Ascites is the most common complication of
liver cirrhosis.
Midodrine is a
vasoconstrictor that improves splanchnic and systemic hemodynamics, reduces
ascites, and improves clinical outcomes. Here, we aimed to examine the role of
midodrine in
cirrhosis-related
ascites. Scopus, Embase, PubMed, and PubMed Central databases were searched for relevant randomized controlled trials comparing
midodrine with other interventions in patients with cirrhotic
ascites on November 25, 2020, using appropriate keywords like "
midodrine", "ascitic
cirrhosis", "peritoneal paracentesis" and suitable Boolean operators. Odds ratio (OR) and mean difference (MD) were used to analyze pool data as appropriate with a 95% confident interval (CI). A total of 14 studies were included in our analysis including 1199 patients. The addition of
midodrine resulted in statistically significant improvement in mean arterial pressure (MAP) (MD, 3.95 mmHg; 95% CI, 1.53-6.36) and MELD (Model for
End-Stage Liver Disease) score (MD, -1.27; 95% CI, -2.49 to -0.04) compared to standard medical treatment (SMT). There was also a significant improvement in plasma
renin activity and plasma
aldosterone concentration. However, there was no significant improvement in mortality or serum
creatinine compared to SMT. In addition, there was no statistically significant improvement in MAP, plasma
renin activity, plasma
aldosterone concentration, MELD score, overall mortality, and paracentesis-induced circulatory dysfunction comparing
midodrine with
albumin.
Midodrine alone leads to significant improvement in various clinical parameters in patients with cirrhotic
ascites compared to standard medical care. At the same time, it was found to be non-inferior to
albumin. Therefore, further well-designed studies need to be carried out on
midodrine in addition to
albumin for optimal clinical benefits among patients with
ascites due to
cirrhosis.