Background. N-terminal probrain natriuretic peptide (NT-proBNP) is a hormone involved in the regulation of cardiovascular homeostasis. Changes in serum NT-proBNP during large volume paracentesis (LVP) in patients with ascites have never before been examined. Aims. To determine if significant changes in serum NT-proBNP occur in patients undergoing LVP and the associated clinical correlates in patients with cirrhosis. Method. A total of 45 patients with ascites were prospectively recruited. Serum NT-proBNP, biochemistry, and haemodynamics were determined at baseline and at key time points during and after paracentesis. Results. 34 patients were analysed; 19 had ascites due to cirrhosis and 15 from malignancy. In those with cirrhosis, NT-proBNP decreased by 77.3？pg/mL at 2？L of drainage and 94.3？pg/mL at the end of paracentesis, compared with an increase of 10.5？pg/mL and 77.2？pg/mL in cancer patients at the same time points ( and ). Only congestive cardiac failure (CCF) was an independent predictor of significant NT-proBNP changes at the end of drainage in cirrhotic patients ( ). There were no significant changes in haemodynamics or renal biochemistry for either group. Conclusion. Significant reductions in serum NT-proBNP during LVP occur in patients with cirrhosis but not malignancy, and only comorbid CCF appeared to predict such changes. 1. Introduction Ascites is the most common cause of hospital admissions in cirrhotic patients. The development of ascites predicts a mortality of approximately 15% and 44% at one and five years, respectively [1]. Total therapeutic large volume paracentesis (LVP) has been shown to be a safe means of treating tense or refractory ascites [2, 3]. Postparacentesis circulatory dysfunction (PCD) describes the development of neurohumoral changes and circulatory disturbances which can arise following fluid shifts induced by LVP in patients with cirrhosis. This syndrome has been associated with a significant increase in intrahepatic vascular resistance, higher rates of ascites recurrence, the development of hepatorenal syndrome, dilutional hyponatraemia, and decreased overall survival [4, 5]. Supplementation with plasma expanders during paracentesis, particularly albumin, can reduce this risk [6, 7]; however, it still occurs in 16–27% of patients [8, 9]. Currently there are no well-defined risk factors that can reliably identify the subset of patients who are at greatest risk of PCD. Brain natriuretic peptide (BNP) is a hormone produced by the cardiac ventricles which is involved in the regulation of fluid volumes and
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