Samira Shojaee1, Marwah Khalid1, George Kallingal1, Le Kang2, Najib Rahman3. 1. Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. 2. Department of Statistics, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. 3. Nuffield Department of Medicine, University of Oxford, Oxford Center for Respiratory Medicine, Oxford, United Kingdom.
Abstract
BACKGROUND: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. OBJECTIVES: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. METHODS: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. RESULTS: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5-14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03-1.36, p = 0.012). CONCLUSIONS: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.
BACKGROUND: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. OBJECTIVES: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. METHODS: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. RESULTS: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5-14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03-1.36, p = 0.012). CONCLUSIONS: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HHpatients. The presence of a previous complication significantly increases the risk of future complications in the HH population.
Authors: Samira Shojaee; Najib Rahman; Kevin Haas; Ryan Kern; Michael Leise; Mohammed Alnijoumi; Carla Lamb; Adnan Majid; Jason Akulian; Fabien Maldonado; Hans Lee; Marwah Khalid; Todd Stravitz; Le Kang; Alexander Chen Journal: Chest Date: 2018-08-29 Impact factor: 9.410
Authors: Karim T Osman; Ahmed M Abdelfattah; Syed K Mahmood; Lina Elkhabiry; Fredric D Gordon; Amir A Qamar Journal: Dig Dis Sci Date: 2022-05-09 Impact factor: 3.487
Authors: Andrea Gallo; Cristina Dedionigi; Chiara Civitelli; Anna Panzeri; Chiara Corradi; Alessandro Squizzato Journal: J Transl Int Med Date: 2020-12-31