Abstract
OBJECTIVES:To present the clinical features and outcomes of outpatients who suffer from refractory ascites.METHODS:This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month.RESULTS:The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R) and 11 non-refractory ascites (NR)]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034). The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively). Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262).CONCLUSION:Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes.
Highlights
IntroductionThe development of ascites is associated with a worse disease prognosis, and the estimated average life expectancy is approximately two years for 50% of cirrhotic patients with ascites and only approximately six months for those with a urinary sodium excretion that is less than 10 mEq/L [2,3,4]
Ascites is one of the most frequent complications of liver cirrhosis and occurs in approximately 50% of patients with compensated liver disease during an observation period of approximately 10 years [1].The development of ascites is associated with a worse disease prognosis, and the estimated average life expectancy is approximately two years for 50% of cirrhotic patients with ascites and only approximately six months for those with a urinary sodium excretion that is less than 10 mEq/L [2,3,4]
hepatic encephalopathy (HE), hernia, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS) type 2 were present in 51%, 44.9%, 38.8% and 26.5%, respectively, of the patients in the refractory ascites group and 9.1%, 18.2%, 0% and 0%, respectively, of the patients in the non-refractory ascites group (p=0.016, p=0.173, p=0.012 and p=0.100, respectively)
Summary
The development of ascites is associated with a worse disease prognosis, and the estimated average life expectancy is approximately two years for 50% of cirrhotic patients with ascites and only approximately six months for those with a urinary sodium excretion that is less than 10 mEq/L [2,3,4]. This condition is observed in cirrhotic patients with refractory ascites, which is indicative of the need for definitive treatment with a liver transplantation.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
