Jacqueline G O'Leary1, K Rajender Reddy2, Puneeta Tandon3, Scott W Biggins4, Florence Wong5, Patrick S Kamath6, Guadalupe Garcia-Tsao7, Benedict Maliakkal8, Jennifer C Lai9, Michael Fallon10, Hugo E Vargas11, Paul Thuluvath12, Ram Subramanian13, Leroy R Thacker14, Jasmohan S Bajaj15. 1. Department of Medicine, Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX, 75216, USA. dr_jackieo@yahoo.com. 2. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Medicine, University of Alberta, Edmonton, AB, Canada. 4. Department of Medicine, University of Washington, Seattle, WA, USA. 5. Department of Medicine, University of Toronto, Toronto, ON, Canada. 6. Department of Medicine, Mayo Clinic, Rochester, MN, USA. 7. Department of Medicine, Yale University, New Haven, CT, USA. 8. Department of Medicine, University of Tennessee Memphis, Tennessee, USA. 9. Department of Medicine, University of California, San Francisco, CA, USA. 10. Department of Medicine, University of Texas, Health Science Center, Houston, TX, USA. 11. Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA. 12. Department of Medicine, Mercy Medical Center, University of Maryland School of Medicine, Baltimore, MD, USA. 13. Department of Medicine, Emory University, Atlanta, GA, USA. 14. Department of Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA. 15. Department of Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA.
Abstract
BACKGROUND: Hepatic hydrothorax (HH) remains a difficult-to-treat complication of cirrhosis. AIM: To define the mortality, length of stay (LOS), and risk of ACLF in patients admitted with HH. METHODS: We utilized the North American Consortium for the Study of End-stage Liver Disease, a prospective cohort of 2868 non-electively hospitalized patients with cirrhosis from 14 tertiary care hepatology centers in North America. A total of 121 patients who required an inpatient thoracentesis (HH group) were compared to 736 patients with refractory ascites without HH, and to 1639 patients without these complications (Other). Patients with a TIPS before or during admission were excluded. RESULTS: There were no differences between the groups in age, gender, or liver disease etiology. Admission MELD (20.5, 21.6 vs. 18.7; p < 0.0001) was lower in HH than RA patients but lowest in other patients, respectively. In hospital, HH patients' rate of second infections and ICU transfer were the highest, and their LOS was the longest of all groups. Despite a similar mean discharge MELD compared to RA patients, the 90-day transplant rate was lower. Multivariable modeling showed patients with HH had an increased risk of ACLF (HR = 2.37 vs. RA, HR = 2.56 vs. Other; p = 0.01) even when controlling for MELD score, AKI, second infection, and history of prior 6-month hospitalization. Multivariable modeling also showed that HH increased the risk of inpatient mortality (HR = 2.22 vs. RA alone, HR = 2.31 vs. Other; p = 0.04). CONCLUSIONS: HH that required a therapeutic thoracentesis more than doubled the risk of ACLF and inpatient mortality among hospitalized patients with cirrhosis.
BACKGROUND:Hepatic hydrothorax (HH) remains a difficult-to-treat complication of cirrhosis. AIM: To define the mortality, length of stay (LOS), and risk of ACLF in patients admitted with HH. METHODS: We utilized the North American Consortium for the Study of End-stage Liver Disease, a prospective cohort of 2868 non-electively hospitalized patients with cirrhosis from 14 tertiary care hepatology centers in North America. A total of 121 patients who required an inpatient thoracentesis (HH group) were compared to 736 patients with refractory ascites without HH, and to 1639 patients without these complications (Other). Patients with a TIPS before or during admission were excluded. RESULTS: There were no differences between the groups in age, gender, or liver disease etiology. Admission MELD (20.5, 21.6 vs. 18.7; p < 0.0001) was lower in HH than RApatients but lowest in other patients, respectively. In hospital, HHpatients' rate of second infections and ICU transfer were the highest, and their LOS was the longest of all groups. Despite a similar mean discharge MELD compared to RApatients, the 90-day transplant rate was lower. Multivariable modeling showed patients with HH had an increased risk of ACLF (HR = 2.37 vs. RA, HR = 2.56 vs. Other; p = 0.01) even when controlling for MELD score, AKI, second infection, and history of prior 6-month hospitalization. Multivariable modeling also showed that HH increased the risk of inpatient mortality (HR = 2.22 vs. RA alone, HR = 2.31 vs. Other; p = 0.04). CONCLUSIONS:HH that required a therapeutic thoracentesis more than doubled the risk of ACLF and inpatient mortality among hospitalized patients with cirrhosis.
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