Increased Risk of ACLF and Inpatient Mortality in Hospitalized Patients with Cirrhosis and Hepatic Hydrothorax
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ORIGINAL ARTICLE
Increased Risk of ACLF and Inpatient Mortality in Hospitalized Patients with Cirrhosis and Hepatic Hydrothorax 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 Received: 11 June 2020 / Accepted: 13 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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 500 mL, in a patient with portal hypertension [1]. It is a complication of cirrhosis that occurs in approximately 5–10% of patients with decompensated cirrhosis [1]. Although most often controlled with diuretics, approximately 25% of patients develop diuretic resistant HH [1]. Despite being reported for the first time in 1937 [2], Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-020-06677-6) contains supplementary material, which is available to authorized users. * Jacqueline G. O’Leary [email protected] Extended author information available on the last page of the article
treatments remain limited, especially since pleurex catheter placement is not recommended in HH [3, 4]. Pleurodesis has been used for HH infrequently, and meta-analysis data has shown some success but with a high rate of complications [5]. Therefore, in all patients who develop HH, transjugular intrahepatic portosystemic shunt (TIPS) placement is considered, but not recommended nor feasible in many patients [6, 7]. A recent study utilized the Nationwide Inpatient Sample to compare the mortality, length of stay and cost of hospitalization of patients with a diagnosis of cirrhosis and hydrothorax to those with only a diagnosis of cirrhosis [8]. Patients who had a thoracentesis for presumed HH had a higher inpatient mortality, longer length of stay and higher inpatient charges compared to those without HH. Although interesting, this data was limited by its dependence on ICD-9 codes, inability to track individual hospitalizations/
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readmissions and absence of hydrothorax etiology. Hence the need for mu
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