Midodrine Versus Albumin for Prevention of Paracentesis Induced Circulatory Disturbance

Inclusion Criteria: 1. Consecutive patients above 18 years of age who fulfilled Asia Pacific Association of study of liver disease (APASL) criteria for ACLF and required paracentesis for moderate to tense ascites were included in the study. 2. Acute on Chronic Liver Failure (ACLF) was defined as an acute hepatic insult manifesting as jaundice (Serum bilirubin ≥ 5 mg/dL (85 micromole/L) and coagulopathy (INR ≥ 1.5 or prothrombin activity \< 40%) complicated within 4 weeks by clinical ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease/cirrhosis and is associated with a high 28-day mortality - Exclusion Criteria: 1. Patients with acute kidney injury defined as serum creatine of \> 0.3 mg/dl above the baseline 2. Severe cardiopulmonary disease 3. History of urinary retention 4. Pheochromocytoma 5. Thyrotoxicosis 6. Persistent and excessive supine hypertension define by systolic blood pressure \> 150 mm Hg 7. Pregnant patients 8. Unable to give informed consent were excluded from the study -