The Mortality of Thoracentesis versus Chest Tube in Hepatic Hydrothorax

Abstract

Introduction: Hepatic hydrothorax is an uncommon complication in patients with liver cirrhosis. About 5% to 10% of patients with cirrhosis develop a hepatic hydrothorax, which may result in dyspnea, hypoxia, and infection, and portends a poor prognosis. Patients with persistent hepatic hydrothorax despite fluid and sodium restriction as well as the use of maximal doses of diuretics generally require drainage. The following article will discuss and review the risk of chest tubes vs. thoracentesis in patients with liver cirrhosis. Methods: We performed a retrospective analysis using the National Inpatient Sample (NIS) database for 2010. People who had a diagnosis of cirrhosis in 2010 were identified using the ICD 9 codes. Then people who had chest tube and/or thoracentesis during the admission were included. Binary logistic regression statistical testing was used to examine the adjusted odd ratio for the mortality rate. A confidence interval (CI) of 95% and P value less than 0.05 were used to define significance Results: A total of 140,573 patients with a diagnosis of cirrhosis were identified. Of this, 1,981 patients had a thoracentesis or chest tube during their hospitalization. 1,776 had a thoracentesis and 205 had a chest tube. Mean length of stay was 7.2 ±15.5 for patient with chest tube and 3.8±10 for patient with thoracentesis (Fig. 1). Mortality was two times higher in those who had chest tube than thoracentesis. The mortality was two times higher in cirrhotic patients who had chest tube compared to non-cirrhotic patients with a chest tube. The mortality was 1.3 times higher in cirrhotic patient who had thoracentesis comparing to non-cirrhotic patients with thoracentesis (Fig 2).Table: Table. Mortality Difference of Chest Tube vs Thoracentesis in CirrhosisTable: Table. Average Length of StayConclusion: Hepatic hydrothorax results from an accumulation of fluid migrating through a diaphragmatic defect from the abdomen into the pleural cavities (more commonly on the right). The mainstay of therapy is similar to that of portal hypertensive ascites and includes sodium restriction, administration of diuretics, and, finally, by mechanical removal. We have demonstrated here that using a chest tube instead of thoracentesis is associated with a greater length of stay, increased mortality, and increased rate of infections. In conclusion, a hepatic hydrothorax should not be treated with a chest tube unless there is frank pus in the pleural fluid or a pneumothorax is present as it leads to significantly worse outcomes.