The Effect of a Large-volume Paracentesis on Fatigue, Sleep, and Quality of Life in Cirrhosis

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2014 by New York University School of Medicine
Information provided by (Responsible Party):
New York University School of Medicine Identifier:
First received: January 24, 2013
Last updated: April 1, 2014
Last verified: April 2014

Ascites is the accumulation of fluid within the peritoneal cavity of the abdomen. It is a frequent complication of cirrhosis that is associated with significant morbidity and poor quality of life. Large-volume ascites has been associated with impaired pulmonary function. In a previous study, the presence and severity of ascites were determined to be significant determinants of fatigue.

In this study, we will determine whether large-volume ascites contributes to fatigue by assessing the response to drainage of ascites by means of a procedure called large-volume paracentesis. We hypothesize that treatment of ascites with a single large-volume paracentesis leads to decreased fatigue and improved quality of life and that this improvement is associated with improved sleep pattern.

20 patients with cirrhosis with refractory ascites requiring regular drainage of ascites fluid by large-volume paracenteses will be recruited for the study. All patients will undergo a complete clinical and physical examination for liver function, including blood tests. Hepatic encephalopathy, a change in mental status associated with liver dysfunction, will be assessed by obtaining historical data and by means of simple bedside neuropsychological examinations.

Study visits will take place on two consecutive days, with each visit lasting approximately 2-3 hours. Immediately prior to a large-volume paracentesis, patients will complete standardized questionnaires for fatigue severity, quality of life, quality of sleep, and a physical assessment of fatigue by means of a 6-minute walk test. Repeat evaluations will be performed 1 day after the procedure. Statistical analysis will then be performed to determine the effect of the paracentesis on the various clinical assessments.

Condition Intervention
Hepatic Encephalopathy
Diuretic-Resistant Refractory Ascites
Procedure: Large Volume Paracentesis

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: The Effect of a Large-volume Paracentesis on Fatigue, Sleep, and Quality of Life in Cirrhosis

Resource links provided by NLM:

Further study details as provided by New York University School of Medicine:

Primary Outcome Measures:
  • Fatigue [ Time Frame: 10 min ] [ Designated as safety issue: No ]
    Patients undergo 6-minute walk test and fill out Fisk Impact Scale (Fatigue Questionnaire)

Secondary Outcome Measures:
  • Hepatic Encephalopathy [ Time Frame: 10 min ] [ Designated as safety issue: No ]
    Patients undergo psychometric testing that involves Trail Making Test and Digit Symbol Substitution Test.

  • Quality of Life [ Time Frame: 5 min ] [ Designated as safety issue: No ]
    Patients fill out Medical Outcomes Study Short Form 36 questionnaire

  • Daytime Sleepiness [ Time Frame: 5 min ] [ Designated as safety issue: No ]
    Patients fill out Epworth Sleepiness Scale questionnaire.

Estimated Enrollment: 20
Study Start Date: July 2012
Estimated Study Completion Date: October 2014
Estimated Primary Completion Date: October 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Fatigue
Fatigue Impact Scale questionnaire, 6-minute walk test
Procedure: Large Volume Paracentesis
procedure done to remove large volume of ascitic fluid that has collected in the peritoneum.


Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Subjects with cirrhosis (based on clinical, laboratory, radiologic evaluation, and liver biopsy, when available) with diuretic-resistant refractory ascites, based on International Ascites Club criteria.[2,31] Specific criteria used for inclusion will be subjects with ascites that cannot be stabilized despite intensive diuretic therapy (e.g., 400 mg of spironolactone with 160 mg of furosemide per day) and dietary sodium restriction (90 mmol of sodium per day) with reappearance of grade 2 or 3 ascites within 4 weeks of mobilization (defined as decrease of ascites at least to grade 1). All subjects must provide separate written consent to undergo a large-volume paracentesis.

Exclusion Criteria:

Subjects will not be eligible for the study if they: (1) have been hospitalized in the previous 1 month for gastrointestinal bleeding, infection, or renal failure; (2) are unable to independently ambulate or have had unstable angina or myocardial infarction within the previous 1 month, as these are contraindications to participating in the 6-minute walk test; (3) are unable to participate in neuropsychological tests or questionnaires; (4) are receiving interferon therapy; (5) have a history of alcohol abuse within the previous 6 months; (6) have a diagnosis of a primary neurologic disorder or uncontrolled psychiatric disorder; or (7) are receiving psychotropic medications such as benzodiazepines and anti-epileptic drugs.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01777971

Contact: Samuel Sigal, MD 212-263-0102

United States, New York
New York University School of Medicine Recruiting
New York, New York, United States, 10016
Contact: Samuel Sigal, MD    212-263-0102   
Principal Investigator: Samuel Sigal, MD         
Sub-Investigator: Omer Ilyas, MD         
Sub-Investigator: Rabia Ali, MD         
Sponsors and Collaborators
New York University School of Medicine
Principal Investigator: Samuel Sigal, MD New York University School of Medicine
  More Information

No publications provided

Responsible Party: New York University School of Medicine Identifier: NCT01777971     History of Changes
Other Study ID Numbers: R11-00672
Study First Received: January 24, 2013
Last Updated: April 1, 2014
Health Authority: United States: New York University School of Medicine Institutional Review Board

Additional relevant MeSH terms:
Liver Cirrhosis
Hepatic Encephalopathy
Liver Diseases
Digestive System Diseases
Signs and Symptoms
Liver Failure
Hepatic Insufficiency
Brain Diseases, Metabolic
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Metabolic Diseases processed this record on September 18, 2014