Comparing the efficacy of midodrine and albumin for preventing Paracentesis-induced Circulatory Dysfunction (PICD) in cirrhotic individuals with ascites undergoing therapeutic paracentesis: A systematic review and meta-analysis

BACKGROUND: Recent studies indicate that alpha-agonists such as midodrine may be effective in preventing paracentesis-induced circulatory dysfunction (PICD). This meta-analysis aims to compare the effect of midodrine versus albumin for preventing PICD in cirrhotic individuals undergoing therapeutic paracentesis. METHODS: A literature search across the MEDLINE, Embase, SCOPUS and Cochrane Library databases was performed in March 2024. We included all studies that compared the efficacy of midodrine to albumin for PICD prevention, as well as studies that investigated changes in serum sodium, serum creatinine and mean arterial pressure (MAP) across the two intervention groups. Risk of bias was assessed using the RoB 2.0 tool. A statistical synthesis was performed for all outcomes where substantial heterogeneity was not present. A sensitivity analysis was performed for the primary outcome, excluding studies of high risk of bias, as well as outcomes with high heterogeneity. RESULTS: Six pilot studies and one RCT were retrieved, encompassing a total of 389 patients. There was no significant difference in PICD incidence between the two groups (OR = 1.65, 95% CI = (0.80, 3.41), p = 0.1787). Midodrine was associated with significantly higher MAP values post-paracentesis in comparison to albumin (MD = 1.55, 95% CI = [0.34, 2.75], p = 0.0116). Most studies reported lower serum sodium values in the midodrine group post-paracentesis, however most of these findings were not significant, whereas no significant differences in serum creatinine changes between the two groups were reported. CONCLUSION: These findings indicate that midodrine may be equally effective to albumin in preventing PICD in cirrhotic patients. As existing evidence is limited, further research is warranted to explore the therapeutic potential of midodrine.