***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Patients with cirrhosis and tense ascites treated by paracentesis  alone have a decrease in effective arterial blood volume after ascites removal . Although intravenous albumin is effective in preventing paracentesis induced decreased arterial blood volume , its clinical use is controversial . As paracentesis induces arteriolar vasodilation which plays a role in the development of decreased effective arterial blood volume , administration of a vasoconstrictor ( terlipressin ) could prevent circulatory alterations due to paracentesis . Aims : To perform a pilot study comparing the effects of terlipressin and albumin on effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites . Methods : Twenty patients with cirrhosis and tense ascites were r and omly assigned to be treated by either paracentesis and terlipressin or paracentesis and albumin . Terlipressin ( 3 mg ) or albumin ( 8 g/l of removed ascites ) were administered on the day of paracentesis . Effective arterial blood volume was assessed by measuring plasma renin concentrations at baseline and on the day of hospital discharge ( 4–6 days after treatment ) . Decreased effective arterial blood volume was defined as an increase in plasma renin concentrations on the day of hospital discharge of more than 50 % of baseline values . Results : Irrespective of the treatment group , mean values for plasma renin concentrations at hospital discharge did not differ from their respective baseline values ( p=0.10 ) . Baseline plasma levels of renin concentrations did not differ between the terlipressin and albumin groups ( p=0.61 ) . Changes from baseline in plasma renin concentrations did not differ between groups ( p=0.39 ) . Three patients in the terlipressin group and three in the albumin group developed decreased arterial blood volume . Conclusions : This r and omised pilot study suggests that terlipressin may be as effective as intravenous albumin in preventing a decrease in effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites OBJECTIVES : Intravenous albumin has been used to prevent paracentesis-induced circulatory dysfunction ( PICD ) in cirrhotics ; however , its use is costly and controversial . Splanchnic arterial vasodilatation is primarily responsible for PICD . There are no reports of use of midodrine in the prevention of PICD . In this pilot study , we evaluated midodrine and albumin in the prevention of PICD . METHODS : Forty patients with cirrhosis underwent therapeutic paracentesis with midodrine or albumin in a r and omized controlled trial at a tertiary center .  Effective arterial blood volume was assessed by plasma renin activity . RESULTS : Plasma renin activity at baseline and at 6 days after paracentesis did not differ in the two groups ( 43.18 ± 10.73 to 45.90 ± 8.59 ng/mL/h , P= 0.273 in the albumin group and 44.44 ± 8.44 to 41.39 ± 10.21 ng/mL/h , P= 0.115 in the midodrine group ) . Two patients had an increase in plasma renin activity of more than 50 % from baseline in the albumin group , and none in the midodrine group . A significant increase in 24-h urine volume and urine sodium excretion was noted in the midodrine group . Midodrine therapy was cheaper  than albumin therapy . CONCLUSIONS : The study suggests that midodrine may be as effective as albumin in preventing PICD in cirrhotics , but at a fraction of the cost , and can be administered orally . Midodrine also result ed in an increase in 24-h urine volume and sodium excretion AIM To investigate the effects of long-term albumin administration on survival , recurrence of ascites and onset of other complications . METHODS One hundred consecutive patients admitted for first-onset ascites were r and omized to receive diuretics plus human albumin 25 g/wk in the first year and 25 g every two wk thereafter ( group 1 ) or diuretics alone ( group 2 ) . The primary endpoint was survival without liver transplantation . Secondary endpoints were recurrence of ascites and occurrence of other complications . RESULTS Median follow-up was 84 ( 2 - 120 ) mo . Albumin-treated patients had significantly greater cumulative survival rate ( Breslow test=7.05 , P=0.0078 ) and lower probability of ascites recurrence ( 51 % versus 94 % , P<0.0001 ) . Chronic albumin infusion result ed in a mean increase in survival of 16 mo . CONCLUSION Long-term albumin administration after first-onset ascites significantly improves patients ' survival and decreases the risk of ascites recurrence Background Transjugular intrahepatic portosystemic shunt ( TIPS ) has recently been reported to be effective in the treatment of cirrhotic patients with refractory ascites . However , the clinical utility of TIPS in the subset of refractory ascitic patients with good hepatic and renal function is uncertain . The aim of this study was to compare the efficacy of TIPS to that of large-volume paracentesis in cirrhotic patients with refractory ascites who have good hepatic and renal function . Methods Sixty cirrhotic patients with refractory ascites who presented with a Child – Pugh score of < 11 , serum bilirubin of <3 mg/dl and creatinine of < 1.9 mg/dl were assigned r and omly to TIPS ( n = 30 ) or large-volume paracentesis plus albumin ( n = 30 ) . The primary endpoint was survival . The secondary endpoints were response to treatment and development of hepatic encephalopathy . Results The baseline characteristics were similar in the two groups . Seventeen patients treated with TIPS and 21 treated with paracentesis  died during the study period . The cumulative probabilities of survival at 1 and 2 years were 80 and 64 % in the TIPS group and 49 and 35 % in the paracentesis group ( p < 0.005 ) . TIPS was significantly superior to paracentesis in the control of ascites ( p < 0.005 ) . Treatment failure was more frequent in the paracentesis group , whereas the frequency of hepatic encephalopathy was greater in the TIPS group . Conclusions In cirrhotic patients with refractory ascites who have good hepatic and renal function , TIPS improves survival and provides better control of ascites than large-volume paracentesis BACKGROUND AND AIMS The clinical utility of transjugular intrahepatic portosystemic shunts ( TIPS ) vis-à-vis total paracentesis in the management of refractory ascites is unclear . METHODS A multicenter , prospect i ve , r and omized clinical trial was performed in which 109 subjects with refractory ascites were r and omized to either medical therapy ( sodium restriction , diuretics , and total paracentesis )  ( n = 57 ) or medical therapy plus TIPS  ( n = 52 ) . The principal end points were recurrence of tense symptomatic ascites and mortality . RESULTS A technically adequate shunt was created in 49 of 52 subjects . TIPS plus medical therapy was significantly superior to medical therapy alone in preventing recurrence of ascites ( P < 0.001 ) . The total number of deaths in the 2 groups was identical ( TIPS vs. medical therapy alone : 21 vs. 21 ) . There were no significant differences in the 2 arms with respect to overall and transplant-free survival . There was a higher incidence of moderate to severe encephalopathy in the TIPS group ( 20 of 52 vs. 12 of 57 ; P = 0.058 ) . There were no significant differences in the number of subjects who developed liver failure ( 7 vs. 3 ) , variceal hemorrhage ( 5 vs. 8) , or acute renal failure ( 3 vs. 2 ) . There were also no significant differences between the 2 groups in the frequency of emergency-department visits , medically indicated hospitalizations , or quality of life . CONCLUSIONS Although TIPS plus medical therapy is superior to medical therapy alone for the control of ascites , it does not improve survival , affect hospitalization rates , or improve quality of life BACKGROUND & AIMS Paracentesis associated with plasma exp and ers is widely used for the treatment of ascites in cirrhosis . This study investigated the clinical importance of paracentesis-induced-circulatory dysfunction and compared the efficacy of albumin , dextran 70 , and polygeline in preventing this complication . METHODS A total of 289 cirrhotic patients with ascites were r and omized to treatment by total paracentesis plus intravenous albumin ( 97 patients ) , dextran 70 ( 93 patients ) , or polygeline ( 99 patients ) . Postparacentesis circulatory dysfunction was defined as an increase in plasma renin activity on the sixth day after paracentesis of more than 50 % of the pretreatment value to a level > 4 ng.mL-1.h-1 . RESULTS Postparacentesis circulatory dysfunction occurred more frequently in patients treated with dextran 70 ( 34.4 % ; P = 0.018 ) or polygeline ( 37.8 % ; P = 0.004 ) than in those receiving albumin ( 18.5 % ) . The plasma exp and er used and the volume of ascites removed were independent predictors of this complication . Postparacentesis circulatory dysfunction persisted during follow-up and was associated with a shorter time to first readmission ( 1.3 + /- 0.5 vs. 3.5 + /- 0.8 months , median + /- SEM ; P = 0.03 ) and shorter survival ( 9.3 + /- 4.2 vs. 16.9 + /- 4.3 months ; P = 0.01 ) . Creatinine and sodium levels in serum , and Child-Pugh score at inclusion , and postparacentesis circulatory dysfunction were independent predictors of survival . CONCLUSIONS Postparacentesis circulatory dysfunction is not spontaneously reversible and is associated with a shorter time to first readmission and shorter survival .  Albumin is the best plasma exp and er to prevent this complication Background Refractory ascites ( RA ) is a complication of cirrhosis which is treated with large volume paracentesis ( LVP ) as the st and ard of care . Alfapump ® system is a fully implantable pump system which reduces the need for LVP . The aim was to assess health-related quality of life ( HRQL ) in patients treated with alfapump ® versus LVP . Methods The data were collected in a multicenter open-label r and omized controlled trial ( clinical trials.gov # NCT01528410 ) . Subjects with cirrhosis Child – Pugh class B or C accompanied by RA were r and omized to receive alfapump ® or LVP .  The SF-36v2 and CLDQ scores were compared between the two treatment arms at screening and monthly during treatment . Results Of 60 subjects r and omized , HRQL data were available for 58 ( N = 27 received alfapump ® and N = 31 received LVP only ) . At baseline , no differences were seen between the treatment arms ( all p > 0.05 ) : age 61.9 ± 8.4 , 79.3 % male , MELD scores 11.7 ± 3.3 , 85.2 % Child – Pugh class B , 70.7 % had alcoholic cirrhosis . The mean number of LVP events/subject was lower in alfapump ® than LVP ( 1.1 vs. 8.6 , p < 0.001 ) . The HRQL scores showed a moderate improvement from the baseline levels in subjects treated with alfapump ® ( p < 0.05 for abdominal and activity scores of CLDQ ) but not with LVP ( all one-sided p > 0.05 ) in the first 3 months . Multivariate analysis showed that treatment with alfapump ® was independently associated with better HRQL at 3 months ( total CLDQ score : beta = 0.67 ± 0.33 , p = 0.05 ) . Conclusion As compared to LVP , the use of alfapump ® system is associated with both a reduction in the number of LVP events and improvement of health-related quality of life The aim of the current study was to compare total paracentesis associated with dextran-40 infusion with diuretics in the treatment of tense ascites in patients with cirrhosis . Eighty patients were r and omly allocated to two groups : 40 patients were treated with  paracentesis plus dextran-40 infusion ( 8 g per liter of ascitic fluid removed ) , and 40 patients with diuretics .  After treatment patients were discharged with diuretics , and patients developing tense ascites during follow up ( 54 + /- 4 weeks ) were treated according to their initial schedule .  Paracentesis  was more effective than diuretics in mobilizing the ascitic fluid . The incidence of complications was significantly higher ( p < 0.05 ) in the diuretic group ( 38 % ) than in the paracentesis group ( 15 % ) . This difference was mainly due to a higher incidence of hepatic encephalopathy in the former group ( 30 % vs. 2.5 % ) . A significantly higher incidence of 
    Output:
    
Based on very low-certainty evidence , there is considerable uncertainty about whether interventions for ascites in people with decompensated liver cirrhosis decrease mortality , adverse events , or liver transplantation compared to paracentesis plus fluid replacement in people with decompensated liver cirrhosis and ascites .
Based on very low-certainty evidence , transjugular intrahepatic portosystemic shunt and adding aldosterone antagonists to paracentesis plus fluid replacement may increase the resolution of ascites compared to paracentesis plus fluid replacement .
Based on very low-certainty evidence , aldosterone antagonists plus loop diuretics may increase the decompensation rate compared to paracentesis plus fluid replacement