Hepatic Hydrothorax-An Independent Decompensating Event Associated with Long-Term Mortality in Patients with Cirrhosis.

Daniela Matei,Bogdan Popovici,Dana Crisan,Tudor Mocan,Sergiu Pasca,Zeno Sparchez,Bogdan Procopet,Roxana Zaharie,Rares Craciun

doi:10.3390/jcm10163688

Daniela Matei, Bogdan Popovici + Show 7 more

Open Access

https://doi.org/10.3390/jcm10163688

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Abstract

Background: Hepatic hydrothorax (HH) is an understudied complication of decompensated cirrhosis. We aimed to evaluate the long-term prognosis of patients with HH by comparing them with a matched non-HH group. Methods: This retrospective study included 763 consecutive patients hospitalized for decompensated cirrhosis and ascites. Ninety-seven patients with HH were matched for survival analysis with non-HH patients based on liver disease severity. Results: The prevalence of HH was 13.1%. Patients with HH had significantly worse overall liver function. Upon matching, patients with HH had a lower long-term survival (15.4% vs. 30.9% at 5 years) with a mean overall survival of 22.2 ± 2.2 months for the HH group vs. 27.1 ± 2.6 months for the non-HH group (Log Rank–0.05). On multivariate survival analysis using Cox regression, the MELD-Na score, ALBI grade, hepato-renal syndrome, and grade III ascites had a significant impact on mortality in patients with HH. In patients with HH, a MELD-Na score ≥ 16, ALBI grade III, hepato-renal syndrome, or severe ascites delineated high-mortality risk groups. Conclusions: HH is consistently associated with more advanced liver disease. Patients with HH have worse long-term survival, their prognosis being closely intertwined with overlapping decompensating events.

Highlights

Between January 2012 and August 2013, seven hundred and sixty-three consecutive patients were hospitalized for decompensated cirrhosis and were considered for inclusion in our study
Patients with HH had a significantly worse liver function expressed by lower serum albumin, total protein, and serum sodium levels and increased total bilirubin and INR
They were in a higher Child–Pugh class, had higher MELD-Na scores, and a higher ALBI grade

Summary

Introduction

Hepatic hydrothorax (HH) is an important, albeit understudied decompensating event in cirrhosis. It is commonly defined as a transudative pleural effusion, typically exceeding 500 mL, in patients with chronic liver disease and portal hypertension, in the absence of underlying cardiopulmonary disease. We aimed to evaluate the long-term prognosis of patients with HH by comparing them with a matched non-HH group. On multivariate survival analysis using Cox regression, the MELD-Na score, ALBI grade, hepato-renal syndrome, and grade III ascites had a significant impact on mortality in patients with HH. In patients with HH, a MELD-Na score ≥ 16, ALBI grade III, hepato-renal syndrome, or severe ascites delineated high-mortality risk groups. Patients with HH have worse long-term survival, their prognosis being closely intertwined with overlapping decompensating events

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