Correlation between increased colloid osmotic pressure and the resolution of refractory ascites after transjugular intrahepatic portosystemic shunt

Background. This study compared the changes In serum albumin, globulin, and colloid osmotic pressure (COP) before and after transjugular intrahepatic portosystemic shunt (TIPS) or large volume paracentesis (LVP) in patients w ith ascites. Methods. Of 23 patients with refractory ascites, 17 had TIPS and 6 had LVP with infusion of albumin. Colloid osmotic pressure measurements were calcul ated, using the formula previously proposed by Hoefs: COP = A (1.058G + 0.1 63A + 3.11) where A = serum albumin and G = serum globulin. Results. After 1 month, ascites resolved in 9 of the 17 patients who had TI PS and in none of the 6 who had LVP, Colloid osmotic pressure increased sig nificantly in patients whose ascites resolved after TIPS. Colloid osmotic p ressure did not change in the patients whose ascites did not resolve after TIPS, and COP decreased significantly in the LVP group. A statistically sig nificant difference was found in the pre-TIPS COP measurements between tl-l ose patients who had resolution of ascites and those who did not. A pre-TIP S COP of less than or equal to 20 mm Hg predicted resolution of ascites wit h an 88% sensitivity and a 78% specificity. Conclusions. Serum COP increased significantly in patients with resolution of ascites but remained unchanged in patients with persistent ascites after TIPS. Serum COP decreased after LW. A statistically significant difference in the pre-TIPS COP was found between patients whose ascites resolved and patients having persistent ascites.