Outpatient interventions for hepatology patients with fluid retention: a review and synthesis of the literature.

Cirrhosis of the liver was the 12th leading cause of death in the United States, according to the 2010 Vital Statistics Report. Cirrhosis is responsible for more than 150,000 hospitalizations each year. Similar to heart failure, severe fluid retention in cirrhotic patients leads to hospitalizations and increase in resource utilization. Outpatient interventions can be used to decrease preventable hospitalizations. The existing literature was explored to determine what interventions can be implemented in an outpatient setting that may reduce or prevent hospital admissions for cirrhotic patients with fluid retention. Seventeen articles were included in the review of the literature. There were 9 randomized controlled trials that yielded a total of 1,694 patients. One meta-analysis yielded 5 randomized controlled trials with 330 patients. Three cohort studies yielded 86 patients. One systematic review yielded 2,115 articles and 2 literature reviews yielded 110 articles. One report from an expert committee was included in the review. Findings from the studies identified 6 main interventions that can be used for outpatient management of cirrhotic patients with fluid retention and may prevent related hospitalizations. These include dietary sodium restriction, diuretics, daily weights, albumin infusions and paracentesis, placement of a transjugular intrahepatic portosystemic shunt, and telephone management.