IDDF2022-ABS-0152 Post-paracentesis ascitic fluid leak in patients with cirrhosis of liver and its management: a prospective study

Abstract

<h3>Background</h3> Ascites is the most common complication of decompensated liver cirrhosis requiring paracentesis for diagnostic and therapeutic purposes. An ascitic fluid leak can develop after paracentesis in patients with cirrhosis leading to significant morbidity if persistent. We aimed to study the incidence and predictors of post-paracentesis leak in patients with ascites. <h3>Methods</h3> In this prospective study, patients with cirrhosis undergoing therapeutic paracentesis were followed up and those who developed persistent leak were included as cases. Controls were randomly selected in a 2:1 ratio from the group of patients who did not develop a leak. Clinical and laboratory parameters were compared between the two groups. <h3>Results</h3> A total of 256 patients underwent 1126 sessions of therapeutic abdominal paracentesis over a period of 14 months. Post-paracentesis leak was seen in 55 (4.8%) patients, while only 20 (1.7%) patients had persistent/major leaks. The management of leak was in a step-wise manner initially with tincture benzoine with tight dressing followed by topical cyanoacrylate adhesive followed by autologous blood patch in those not responding. Patients who had major leak had a higher proportion of patients with parietal edema, higher PT-INR and Child-Pugh score and lower mid-upper arm circumference, short physical performance battery score and hand-grip strength. On multivariate analysis, only the presence of parietal edema was an independent predictor of post-paracentesis persistent leak (Odds ratio 10.35, 95% confidence interval 1.61 – 66.54, p = 0.014). Based on the study’s findings, we propose a step-wise approach to managing post-paracentesis leak developing in patients with cirrhosis (IDDF2022-ABS-0152 Figure 1. Approach to step-wise management of post paracentesis leak in cirrhosis). <h3>Conclusions</h3> Persistent leak after paracentesis develops in a minority of patients with cirrhosis. The presence of parietal edema is a risk factor for a major leak. The majority of these patients can be managed with a step-wise approach.