Clinical characteristics and outcome of patients with cirrhosis and refractory ascites

Background: In patients with cirrhosis, refractory ascites is associated with a poor prognosis and is an indication for liver transplantation. However, factors that determine prognosis remain unclear. Aims: To investigate the predictive factors of prognosis in patients with refractory ascites. Methods: Seventy-five patients with refractory ascites were followed-up for 18+/-13 months (mean+/-SD) and survival was analyzed. Results: The 1-year probability of survival was 52%. Univariate analyses showed that older patients, hepatocellular carcinoma and diabetes, all assessed at entry, were associated with significantly increased risk ratios of death. The risk ratio of death was significantly lower in abstinent alcoholics than in patients with nonalcoholic cirrhosis. The risk ratio of death did not significantly differ between patients with nonalcoholic cirrhosis and nonabstinent alcoholics. Child-Pugh score at entry had no prognostic value. Multivariate analysis showed that older age, hepatocellular carcinoma, diabetes and abstinence were independent prognostic factors. Conclusions: In patients with cirrhosis and refractory ascites, older age, hepatocellular carcinoma and diabetes, but not Child-Pugh score at entry, were independent predictive factors of poor survival while abstinence was an independent predictive factor of good survival. These findings should be taken into account when deciding on liver transplantation in patients with refractory ascites.