4.4 Article

Refractory Hepatic Hydrothorax Is an Independent Predictor of Mortality When Compared to Refractory Ascites

Journal

DIGESTIVE DISEASES AND SCIENCES
Volume 67, Issue 10, Pages 4929-4938

Publisher

SPRINGER
DOI: 10.1007/s10620-022-07522-8

Keywords

Cirrhosis; Mortality; MELD-Na; Liver transplant; Hepatic hydrothorax; Ascites

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Refractory hepatic hydrothorax is an independent predictor of mortality and provides 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.

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