Trial reportHepatology international2025
Addition of midodrine to albumin reduces the incidence of complications of large-volume paracentesis: an RCT comparing midodrine, terlipressin, and albumin.
Trial report in Hepatology international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Low-Dose vs. Standard Care Iv Human Albumin During Large-Volume Paracentesis in Patients With Liver Cirrhosis: A Systematic Review.Liver international : official journal of the International Association for the Study of the Liver · 2026Pooled it
- Midodrine versus placebo in patients with acute-on-chronic liver failure with ascites-A randomized trial (MIDAS trial).Hepatology communications · 2026Trial
- Acute-on-chronic liver failure: pathophysiological mechanisms and clinical management.Nature reviews. Gastroenterology & hepatology · 2026Review
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsLarge-volume paracentesis (LVP), a therapeutic procedure for cirrhosis patients with refractory ascites, is associated with paracentesis-induced circulatory dysfunction (PICD). While albumin infusion is known to prevent PICD, it is unknown whether the addition of vasoconstrictors to albumin reduces complications of LVP.
methodsCirrhosis patients undergoing LVP for refractory ascites were randomized to receive albumin alone (Gr. I), terlipressin with albumin (Gr.II), or midodrine with albumin (Gr. III). The primary endpoint was the incidence of PICD, and the secondary endpoints were the incidence of new-onset complications (hyponatremia, acute kidney injury, and encephalopathy), 28-day survival and adverse events to therapy.
resultsOne hundred and sixty-fifty cirrhosis patients with refractory ascites undergoing LVP were equally randomized to 3 groups. The incidence of PICD in Gr. I (14%), II (7%), and III (11%) was similar (p = 0.46). Mean arterial pressure (MAP) reduced in Gr.I and II compared to the rise in Gr. III on day 3 (ΔMAP: Gr.I = - 8.2 ± 5.01; Gr.II = - 4.34 ± 5.82; Gr. III = 9.16 ± 5.14 mmHg; p < 0.001), with a statistically significant rise in PRA (ng/ml/hour) at day 6 in Gr. I and II than in Gr. III. The incidence of new-onset complications was significantly higher in Gr.I (52.72%) and Gr.II (45.46%) than Gr.III (23.63%) (p = 0.005). Overall mortality on day 28 was not different between the groups.
conclusionsPICD remains a challenge even in hospitalized settings. The addition of oral midodrine to albumin prevents hypotensive response on day 3, thereby reducing the incidence of new-onset complications following LVP.
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Registered trials
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