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Abstract
Ascites is the most common complication of liver cirrhosis and its development is associated with worsened quality of life. If indicates poor prognosis especially those with refractory type.
This study was designed to evaluate the role of furosemide natriuresis test in rapid determination of truly refractory (resistant) ascites.
Forty three patients with post hepatitic cirrhosis and tends ascites were selected from those admitted to Ain Shams University Hospital Internal Medicine Department. All of them were subjected to the following:
1. Liver enzymes (AST and ALT), serum albumin, serum bilirubin (direct and indirect) and prothrombin time.
2. Urea, creatinine and creatinine clearance.
3. Abdominal ultrasound.
4. Viral markers.
5. Diagnostic abdominal paracentesis.
6. Serum sodium and potassium before and after the test.
Furosemide natriuresis test was done. Then all patients were given the maximum oral diuretic therapy for one week under dietary sodium restrict-ion. Results of the test were statistically analyzed and compared to those of oral therapy and sensitivity, specificity, PPV and NPV of the test were calculated.
Results revealed that the test is highly sensitive (sensitivity 100%) but not highly specific (specificity 90.3%) with PPV 80% and NPV 100%. The test was also found to be relatively safe as regard hypotension and hypokalemia as no clinical manifestations could be detected after it.
We concluded that furosemide natriuresis test can be used in rapid determination of responsive and resistant cases of post hepatitic cirrhotic ascites with sensitivity 100%, specificity 90.3%, PPV 80% and NPV 100%. Although, the relative safety of the test close monitoring of blood pressure and K level is highly recommended. It is also recommended to reevaluate the test on larger sized sample of patients and by other valid statistical methods.