Karim T Osman1, Ahmed M Abdelfattah2, Syed K Mahmood2, Lina Elkhabiry3, Fredric D Gordon4,5, Amir A Qamar4,5. 1. Department of Internal Medicine, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA. Ktarek.osman@gmail.com. 2. Department of Gastroenterology, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA. 3. Department of Internal Medicine, University of Alexandria, Alexandria, Egypt. 4. Department of Transplant and Hepatobiliary Diseases, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA. 5. Tufts University School of Medicine, Boston, MA, USA.
Abstract
BACKGROUND: Hepatic hydrothorax (HHT) is an uncommon but significant complication of cirrhosis and portal hypertension, associated with a worse prognosis and mortality. Nearly 25% of patients with HHT will have refractory pleural effusion. It is unclear if refractory HHT has a different prognosis compared to refractory ascites. AIMS: We aim to evaluate the prognostic significance of refractory HHT when compared to refractory ascites. METHODS: Forty-seven patients who had refractory HHT in a tertiary care center were identified, and matched, retrospectively, one-to-one by age, gender and MELD-Na with 47 patients with refractory ascites. One-year mortality rate was compared between both groups. Cox proportional hazard regression was used to identify the association between different covariates and primary endpoint. RESULTS: The 1-year mortality was 51.06% in the HHT group compared to 19.15% in the refractory ascites group. The median survival for patients with refractory hepatic hydrothorax was 4.87 months while the median survival for patients with refractory ascites exceeded 1 year. The presence of HHT was statistically significant in predicting the development of 1-year mortality [Hazard Ratio (HR) 4.45, 95% Confidence Interval (CI) 2.25-8.82; P value < 0.001]. Furthermore, refractory HHT remained associated with one-year mortality after adjusting for all other covariates. In a subgroup of patients with MELD-Na ≤ 20, HHT continued to be a significant predictor of one-year mortality (HR 3.30, 95% CI 1.47-7.40; P value 0.004). CONCLUSIONS: Refractory HHT is a significant independent predictor of mortality and offers additional prognostic value.
BACKGROUND: Hepatic hydrothorax (HHT) is an uncommon but significant complication of cirrhosis and portal hypertension, associated with a worse prognosis and mortality. Nearly 25% of patients with HHT will have refractory pleural effusion. It is unclear if refractory HHT has a different prognosis compared to refractory ascites. AIMS: We aim to evaluate the prognostic significance of refractory HHT when compared to refractory ascites. METHODS: Forty-seven patients who had refractory HHT in a tertiary care center were identified, and matched, retrospectively, one-to-one by age, gender and MELD-Na with 47 patients with refractory ascites. One-year mortality rate was compared between both groups. Cox proportional hazard regression was used to identify the association between different covariates and primary endpoint. RESULTS: The 1-year mortality was 51.06% in the HHT group compared to 19.15% in the refractory ascites group. The median survival for patients with refractory hepatic hydrothorax was 4.87 months while the median survival for patients with refractory ascites exceeded 1 year. The presence of HHT was statistically significant in predicting the development of 1-year mortality [Hazard Ratio (HR) 4.45, 95% Confidence Interval (CI) 2.25-8.82; P value < 0.001]. Furthermore, refractory HHT remained associated with one-year mortality after adjusting for all other covariates. In a subgroup of patients with MELD-Na ≤ 20, HHT continued to be a significant predictor of one-year mortality (HR 3.30, 95% CI 1.47-7.40; P value 0.004). CONCLUSIONS: Refractory HHT is a significant independent predictor of mortality and offers additional prognostic value.
Authors: Jacqueline G O'Leary; K Rajender Reddy; Puneeta Tandon; Scott W Biggins; Florence Wong; Patrick S Kamath; Guadalupe Garcia-Tsao; Benedict Maliakkal; Jennifer C Lai; Michael Fallon; Hugo E Vargas; Paul Thuluvath; Ram Subramanian; Leroy R Thacker; Jasmohan S Bajaj Journal: Dig Dis Sci Date: 2020-11-13 Impact factor: 3.199
Authors: Scott W Biggins; Paulo Angeli; Guadalupe Garcia-Tsao; Pere Ginès; Simon C Ling; Mitra K Nadim; Florence Wong; W Ray Kim Journal: Hepatology Date: 2021-08 Impact factor: 17.425
Authors: Patrick M Bossuyt; Johannes B Reitsma; David E Bruns; Constantine A Gatsonis; Paul P Glasziou; Les Irwig; Jeroen G Lijmer; David Moher; Drummond Rennie; Henrica C W de Vet; Herbert Y Kressel; Nader Rifai; Robert M Golub; Douglas G Altman; Lotty Hooft; Daniël A Korevaar; Jérémie F Cohen Journal: BMJ Date: 2015-10-28