DIURETICS VS PARACENTESIS FOLLOWED BY DIURETICS IN CIRRHOSIS - EFFECTON ASCITES OPSONIC ACTIVITY AND IMMUNOGLOBULIN AND COMPLEMENT CONCENTRATIONS

Ascitic fluid opsonic activity and ascitic fluid C3 concentrations are important protective factors against spontaneous bacterial peritoniti s. This randomized controlled study was performed to compare the effec t of diuretic administration alone vs. single large-volume therapeutic paracentesis followed by administration of diuretics on ascitic fluid opsonic activity and on ascites and serum immunoglobulin and compleme nt concentrations in patients with alcoholic cirrhosis and tense ascit es. Twenty-one patients were randomly allocated to two groups: group 1 included 11 patients who were treated with diuretics alone, and group 2 included 10 patients who were treated with single large-volume ther apeutic paracentesis (5 to 6 L of ascites removed) followed by diureti cs. Ascitic fluid opsonic activity and serum and ascites immunoglobuli n and complement concentrations were measured at the beginning and at the end of treatment. The ascitic fluid opsonic activity increased sig nificantly in patients treated with diuretics alone (p < 0.05), wherea s in the group of patients treated with therapeutic paracentesis follo wed by diuretics, the ascites opsonic activity remained stable. Althou gh ascitic fluid IgG, IgA and C3 concentrations increased significantl y in patients treated with diuretics alone (p < 0.05), ascitic fluid C 3 concentration significantly decreased in patients from group 2 (p < 0.05), whereas IgG and IgA concentrations remained unchanged. However, in both groups of patients serum immunoglobulin and complement concen trations remained unchanged. This study suggests that in cirrhotic pat ients with tense ascites, treatment with diuretics alone may have the potential advantage over single large-volume therapeutic paracentesis followed by the administration of diuretics of providing better protec tion from spontaneous bacterial peritonitis. However, further investig ations are necessary to demonstrate the relevant clinical incidence of spontaneous bacterial peritonitis in cirrhotic patients with tense as cites treated either with diuretics alone or with single large-volume therapeutic paracentesis followed by diuretics.