Ascites In Cirrhotic Patients Research Articles

Comparison of Prognostic Value of Predictors of Mortality in Patients with Cirrhosis and Refractory Ascites

The Model for End-Stage Liver Disease-Sodium score (MELDNa) has been developed that has a better prognostic value to predict early mortality but has not been frequently used in cirrhotic and refractory ascites patients with recurrent incidences of severe hyponatremia. Objective: To compare the prognostic value of severe hyponatremia, Child-Pugh score, and the model for end-stage liver disease-sodium score in cirrhotic and refractory ascitic patients. Methods: A prospective, observational study was conducted at the Hepatology Department, Bakhtawar Amin Trust Hospital, Multan from March 2023 to March 2024. A total of 200 patients with cirrhosis and refractory ascites undergoing albumin paracentesis twice a month were selected for the study. The 135 patients (after exclusion of preexisting ascites patients) were administered diuretics symmetrically; 50 mg spironolactone and 40 mg furosemide in patients who did not have renal failure and severe hyponatremia. Prognostic scores were recorded and patients were followed up for minimum 3 months. Results: The area under the curve of the Child-Pugh score (0.90, 95% CI: 0.87-0.96) was significantly higher than the MELD score (0.60, 95 CI: 0.51-0.70) and MELDNa (0.75, 95% CI: 0.65-0.79) as a predictor of mortality (p<0.0001). With respect to the etiology of refractory ascites being an independent risk factor of mortality, the cumulative incidence function was highest in patients with hyponatremia (79%; 95% CI: 79-80%) followed by renal failure patients (55%; 95 CI: 54-56%) and patients receiving maximum dose of treatment (28%; 95% CI: 27-29%) (p<0.001). Conclusions: Severe hyponatremia, ineffective diuretic treatment, and Child-Pugh score were risk factors of death in cirrhotic and refractory ascitic patients.

Ascites in cirrhotic patients: a comprehensive review

Ascites is a frequent complication in patients with cirrhosis, associated with a bad prognosis. Ascites is associated with severe complications, such as spontaneous bacterial peritonitis and kidney dysfunction, which must be diagnosed and managed rapidly. First-line management is based on diuretics use. Beta-blockers role remains debated but an early administration could probably decrease complications associated with portal hypertension. Albumin infusion is validated in large volume paracenteses, spontaneous bacterial peritonitis, or kidney dysfunction, but is debated in other situations. Technical progresses allow the worldwide use of TIPS (transjugular intrahepatic portosystemic shunt), but patient selection must be rigorous because of potential severe complications. An alternative treatment, automated low-flow ascites pump, can be offered in patients without TIPS possibility: It is a recent technique, whose patients’ selection and installation conditions were improved, with interesting results. Liver transplantation remains the gold standard, but the lack of grafts, and specific side effects, lead to prefer other methods. In case of acute kidney injury due to hepatorenal syndrome, terlipressin remains the standard of care; continuous infusion is associated with fewer side effects.

Frequency of spontaneous bacterial peritonitis among cirrhotic ascitic patients and predictors for its outcome in Menoufia University Hospitals

Frequency of spontaneous bacterial peritonitis among cirrhotic ascitic patients and predictors for its outcome in Menoufia University Hospitals

Prevention of Post-Hepatectomy Liver Failure in Cirrhotic Patients Undergoing Minimally Invasive Liver Surgery for HCC: Has the Round Ligament to Be Preserved?

Post-hepatectomy liver failure (PHLF) represents a major cause of morbidity and mortality after liver resection. The factors related to PHLF are represented not only by the volume and function of the future liver remnant but also by the severity of portal hypertension. The aim of this study was to assess whether the preservation of the round ligament (RL) may mitigate portal hypertension, thus decreasing the risk of PHLF and ascites in cirrhotic patients while undergoing minimally invasive liver surgery (MILS). All the cirrhotic patients who underwent MILS for HCC from 2016 to 2021 in two international tertiary referral centers were retrospectively analyzed, comparing cases with the RL preserved vs. those with the RL divided. Only patients with cirrhosis ≥ Child A6, portal hypertension, and ICG-R15 > 10% were included. Main postoperative outcomes were compared, and the risk factors for postoperative ascites (severe PHLF, grade B/C) were investigated through a logistic regression. After the application of the selection criteria, a total of 130 MILS patients were identified, with 86 patients with the RL preserved and 44 with the RL divided. The RL-preserved group showed lower incidences of severe PHLF (7.0% vs. 20.5%, p = 0.023) and ascites (5.8% vs. 18.2%, p = 0.026) in comparison with the RL-divided group. After uni/multivariate analysis, the risk factors related to postoperative ascites were RL division and platelets < 92 × 103/µL, calculated with ROC analysis. The preservation of the round ligament during MILS may mitigate portal hypertension, preventing PHLF and ascites in cirrhotic patients with borderline liver function.

Prevention of post hepatectomy liver failure and ascites in cirrhotic patients undergoing minimally invasive liver surgery for HCC: has the round ligament to be preserved?

Prevention of post hepatectomy liver failure and ascites in cirrhotic patients undergoing minimally invasive liver surgery for HCC: has the round ligament to be preserved?

The serum-ascites vitamin D gradient: a diagnostic marker for spontaneous bacterial peritonitis in Egyptian cirrhotic patients

Background The most prevalent infectious consequence of liver cirrhosis is spontaneous bacterial peritonitis (SBP). Ascitic fluid polymorph nuclear neutrophils (PMN) counts of more than 250 cells/µL are used as the gold standard for diagnosing SBP. Patients with decompensated cirrhosis also had significantly decreased serum 25-OH vitamin D levels compared with controls. Aim Our aim is to investigate the role of (serum ascites vitamin D gradient) as a diagnostic factor for diagnosis of SBP. Patients and method This cross-sectional study included 80 cirrhotic ascitic patients from Egypt who were treated at the hospitals affiliated with the Tropical Medicine and Infectious Diseases Department at Tanta University. Group 1: 40 ascitic patients with SBP. Group 2: 40 ascitic patients without SBP History taking, clinical examination, laboratory analysis, and imaging studies were applied to every patient. Results Child-Pugh score was significant in both groups as child C was significantly higher in group 1 than group 2. Total leucocyte count and differential neutrophil were significantly higher in group 1 than group 2 while child B was higher in group 2 than group 1. Differential lymphocyte was significantly lower in group 1 than group 2. SADG was significantly lower in group 1 than group 2. SADG ratio can significantly predict SBP (P = 0.036 and AUC = 0.632) at cut-off less than or equal to −25.8 with 37.50% sensitivity, 95.00% specificity, 88.2% positive predictive value (PPV), and 60.3% negative predictive value (NPV). Conclusion Patients with cirrhotic ascites had decreased SADG and higher SBP. In these cases, it might be used as a diagnostic and prognostic marker for SBP. Patients with decompensated cirrhosis, independent of SBP, have an increased prevalence of vitamin D insufficiency.

Association of serum sodium and 24-hour urinary sodium level with the severity and complications of ascites in cirrhotic patients.

Hyponatremia is an independent predictor of mortality in cirrhotic patients but little is known regarding the relationship between the level of serum sodium and 24-hour urinary sodium with the development of severity and complications of cirrhotic ascites. To observe the association of serum sodium and 24-hour urinary sodium levels with different grades of ascites and its complications in cirrhotic patients. In the department of Gastroenterology in a tertiary care hospital, this cross-sectional study was conducted from April 2019 to September 2020. A total of 96 admitted cirrhotic patients with ascites were enrolled in this study by consecutive sampling. Out of 96 patients with cirrhotic ascites, 48 patients had mild, moderate, and severe ascites and 48 patients had complications of ascites like refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome. The mean serum sodium level was 131.69 ± 4.90 and 124.88 ± 5.67 mmol/L and the 24-hour urinary sodium level was 76.82 ± 45.64 and 35.26 ± 22.57 mmol/L in uncomplicated and complicated ascites groups respectively with P value < .001. In grade 1, grade 2, and grade 3 ascites, there was a significant (P = .001), association between mean serum sodium (mmol/L) level (R -0.777) and 24-hour urine sodium (mmol/L) level (R -0.704) but no significant difference was seen when refractory ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome were considered. In our finding, low serum sodium and low 24-hour urinary sodium levels were associated with the development of severe complications of cirrhotic ascites. Hence, Serum sodium and 24-hour urinary sodium levels can be good predictors of grading and complications of cirrhotic ascites.

The Predictors of Hepatorenal Syndrome Development in HCV Cirrhotic Ascitic Egyptian Patients with Spontaneous Bacterial Peritonitis.

Spontaneous bacterial peritonitis is considered a precipitating factor for renal impairment in patients with liver cirrhosis. No specific study addressing this problem has been reported. This study aimed to detect the incidence and predictive factors of hepatorenal syndrome in these patients. This study enrolled 121 hepatic cirrhotic patients with spontaneous bacterial peritonitis. History taking, clinical examination, and laboratory investigations including ascitic fluid analysis were carried out. Kidney function tests were repeated 3 days after the initiation of treatment. Patients were divided into 2 groups after one week of treatment during the follow-up period: Group I: patients without hepatorenal syndrome, and Group II: patients with hepatorenal syndrome. Multivariate analysis was performed to determine independent predictors of hepatorenal syndrome development. A total of 30 patients (24.8%) developed hepatorenal syndrome. Patients with hepatorenal syndrome had significantly lower sodium and albumin levels as well as higher creatinine, bilirubin, Child-Turcotte-Pugh score, portal vein diameter, Model for End-Stage Liver Disease score. Higher percentage of them had a history of recurrent spontaneous bacterial peritonitis and multiple therapeutic paracentesis of ascites. Multivariate analysis detected that serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter were significant predictors of hepatorenal syndrome. Cutoff values were determined as 3.3 mg/dl for bilirubin, 15.9 mm for portal vein diameter, and 26 for Model for End-Stage Liver Disease-Sodium. Hepatorenal syndrome is a common complication of spontaneous bacterial peritonitis. In our study, high serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter are predictors of the development of hepatorenal syndrome in patients with spontaneous bacterial peritonitis.

Epidemiology, causes, and management of ascites; a systematic review

The main malignancy of hepatocytes, hepatocellular carcinoma (HCC) is a medical condition with a poor prognosis. Spontaneous bacterial peritonitis (SBP), a common infection in individuals with cirrhosis and ascites, has high morbidity and mortality. Thus this study aimed to investigate the prevalence, etiology, and treatment of ascites. English-language articles were collected from 2015 to 2023 demonstrating the management of epidemiology, causes, and management of ascites. Overall, there were 5 articles. Surveys and analyses of national databases were the most widely used methods (n=5). Sociodemographic information, symptoms, warning signals, risk factors, historical medical conditions, findings from significant investigations, and potential advanced management alternatives were all gathered. Intractable ascites indicated a bad prognosis in people with liver cirrhosis and frequently aggravated decompensated hepatic cirrhosis. Treatment and management options vary. Aldosterone blockers and loop diuretics are the mainstays for the treatment of ascites in cirrhotic patients, while vasopressin receptor antagonists are infrequently utilized. The sodium-glucose cotransporter 2 (SGLT2) inhibitors might be a novel ascites treatment with a different mechanism than currently prescribed drugs, according to recent findings. Additionally, urinary neutrophil gelatinase-associated lipocalin can be used to predict the incidence of acute kidney injury following the administration of tolvaptan and is a helpful predictor of tolvaptan\&amp;apos;s short- and long-term effectiveness.

Serum copeptin is associated with major complications of liver cirrhosis and spontaneous bacterial peritonitis.

We aimed to investigate the possible association between serum copeptin and complications of liver cirrhosis, including its potential role as a stress biomarker in spontaneous bacterial peritonitis (SBP). This cross-sectional study included 89 cirrhotic ascitic patients (37 with SBP and 52 without SBP) admitted to Sohag University Hospitals, Egypt, between June 2021 and February 2022. Serum copeptin was measured in all patients, and its association with SBP and other complications of liver cirrhosis was investigated. Serum copeptin was significantly elevated in patients with SBP compared to those without SBP (p = 0.032) and significantly correlated with ascitic fluid study parameters, systemic inflammatory markers, and liver, renal, and circulatory functions. Serum copeptin and C-reactive protein (CRP) were independent risk factors for the presence of SBP. Serum copeptin detects SBP at a cut-off value of 9 pmol/l, with sensitivity and specificity of 73% and 64%, respectively. Serum copeptin was significantly associated with hepatic encephalopathy, gastrointestinal bleeding, hepatorenal syndrome, and larger amounts of ascites. Serum copeptin is an independent risk factor for the presence of SBP and significantly increased in patients presented with major complications of liver cirrhosis, demonstrating its ability to reflect circulatory dysfunction and systemic inflammation.

P-089 SPONTAONEUS BOWEL EVISCERATION IN UMBILICAL HERNIA: CASE REPORT

Abstract Aim Spontaneous rupture of sac of hernia is a less common complication and mainly associated to persistent ascites or congenital wall defects. In literature we have few cases of spontaneous bowel eviscerations in umbilical hernias. Case Report a 53-year-old male years old man addicted to heroin, cocaine and alcohol, presented to the Emergency Department with evisceration of small bowel through an existing umbilical hernia. The patient was conscious and not complaining pain. He stated a protrusion of small bowel through his umbilical skin caused to sudden coughing after assumption of a dose of heroin.In emergency room showed an ileal loop with sub ischemic features. Blood test revealed an hepatitis C infection. During the urgent laparotomy there wasn't evidence of ascites and was necessary to performed an ileal resection and latero-lateral anastomosis with mechanical suturing machine. The placement of a prosthesis was performed; therefore, direct plastic surgery of the abdominal wall. After surgery with a short stay in ICU of 24 hours, the patient was discharged in POD 5. The postoperative course was regular without wound complications. After four months he was free from recurrence and VAS was 0. Conclusions Spontaneous bowel eviscerations in umbilical hernias is associated with refractory ascites in cirrhotic patients or congenital defect. This case is one of few case depicted in literature as spontaneous evisceration of bowel in non cirrhotic patient with umbilical hernia.

Safety, Tolerability, Pharmacokinetics, and Efficacy of Terlipressin Delivered by Continuous Intravenous Infusion in Patients with Cirrhosis and Refractory Ascites

Background. Terlipressin is a long acting synthetic analogue of vasopressin, which is used to manage variceal bleeding and hepatorenal syndrome. Terlipressin is being developed to treat refractory ascites in cirrhotic patients who are no longer responsive to diuretic drugs and require repeated paracentesis. This study evaluated the safety, tolerability, pharmacokinetics (PK), and efficacy of a continuous intravenous (IV) infusion of terlipressin as an outpatient treatment for refractory ascites in patients with advanced liver cirrhosis. Methods. This was an open-label Phase 2a trial. Patients received a continuous IV infusion of terlipressin 2 mg/day escalating to 4 mg/d during an initial 7-day inpatient period, followed by 21 days as outpatients. The PK, safety/tolerability, and effects on the need for and volume of paracentesis were evaluated. Results. Four of 6 patients experienced ≥50% increase in the interval between large volume paracenteses (LVP) with terlipressin. The volume of ascites removed by LVP in the 28-day treatment period was reduced in all patients by ≥30% compared with pretreatment. Terlipressin was rapidly eliminated with a mean half-life of 42.3 minutes, mean clearance of 5.6 mL/min/kg, and volume of distribution of 0.33 L/kg. Average steady state plasma concentrations ranged from 1.69 to 5.55 ng/mL and increased proportionally with increasing dose. Three (50.0%) patients reported treatment-related adverse events, but none were serious. Conclusion. Continuous terlipressin IV infusion improved control of refractory ascites with an acceptable safety and predictable PK profile. Further evaluation of terlipressin is warranted in a randomized controlled trial for treating refractory ascites and related complications of cirrhosis.

Comparison of Low Dose Albumin Versus Full Dose Albumin in Improving Refractory Ascites in Cirrhotic Patients

Background: Refractory ascites is one of the most important complications of cirrhosis &amp; albumin is considered highly effective in controlling it. Objective: To compare efficacy of 10g albumin versus 20g albumin in improving refractory ascites in cirrhotic patients.&#x0D; Methods: This randomized control trial was conducted at department of Gastroenterology, Mayo hospital Lahore for 12 months. After ethical approval, 60 patients of chronic liver disease with refractory ascites were included in the study &amp; were divided into two groups. Group A was administered with 20g albumin whereas; group B was given 10g albumin. Both groups were followed for next 3 days by measuring change in weight, abdominal girth and urine output. Data was analyzed by using SPSS v-21. Results: There was no considerable difference between two groups regarding change in weight, abdominal girth and urine output. There was no significant difference in albumin response for both the groups in reducing ascites (p=0.6022). Conclusion: Low dose albumin is as effective as full dose albumin for reducing refractory ascites among cirrhotic patients. &#x0D;

Predictors of Recurrence of Spontaneous Bacterial Peritonitis in Cirrhotic Ascitic Patients

Predictors of Recurrence of Spontaneous Bacterial Peritonitis in Cirrhotic Ascitic Patients

A comparative study on nosocomial and community-acquired spontaneous bacterial peritonitis in patients with liver cirrhosis at a university hospital.

The serious nature of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and the need for timely effective empirical antibiotic therapy in the context of the global surge of antimicrobial resistance and changing epidemiology necessitate a periodic review of the local epidemiologic features of the disease. The aim of the study is to investigate the differences in bacterial profile and antibiotic resistance between nosocomial and community-acquired SBP in patients with liver cirrhosis to guide empirical antibiotic choices for better outcomes. This cross-sectional study included 95 ascitic cirrhotic patients diagnosed with SBP. According to the setting in which the infection was acquired, the patients were divided into two groups: nosocomial and community-acquired SBP. The bacterial profile and rates of multidrug resistance (MDR) phenotype and the extended-spectrum β-lactamase (ESBL) production among Gram-negative isolates in both groups were compared. Escherichia coli was the most frequently isolated bacteria (60% of all isolates) followed by Klebsiella pneumoniae (11.4%). Gram-positive bacteria were only isolated from nosocomial SBP cases; the most common was Staphylococcus aureus (11.4%) followed by coagulase-negative staphylococci (5.7%). High rates of resistance to third-generation cephalosporins, the first-line empirical treatment of SBP, were detected (76.6-100% in nosocomial isolates and 25-87% in community isolates). Carbapenems, amikacin and gentamycin showed good activity against Gram-negative bacilli in both nosocomial and community-acquired isolates. MDR bacteria, including ESBL-producing Enterobacteriaceae, were significantly associated with nosocomial SBP. The significant increase in MDR phenotype and ESBL production among nosocomial isolates necessitates a change in the initial empirical therapy for nosocomial SBP and carbapenems seem good alternatives.

Rapid detection for infected ascites in cirrhosis using metagenome next-generation sequencing: A case series.

Empirical antibiotic therapy in patients with spontaneous bacterial peritonitis (SBP) is common as pathogen(s) are identified in only 5%-20% patients using conventional culture-based techniques. Metagenome next-generation sequencing (mNGS) test is a promising approach for the diagnosis of infectious disease. The clinical application of mNGS for infected ascites in cirrhotic patients is rarely reported. Here, we describe three cases to preliminarily explore the potential role of mNGS for microbiological diagnosis of ascites infection in an exploratory manner. The clinical performance of ascites mNGS in cirrhotic patients remains to be further evaluated.

Explainable machine learning model for predicting spontaneous bacterial peritonitis in cirrhotic patients with ascites

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with cirrhosis. We aimed to develop an explainable machine learning model to achieve the early prediction and outcome interpretation of SBP. We used CatBoost algorithm to construct MODEL-1 with 46 variables. After dimensionality reduction, we constructed MODEL-2. We calculated and compared the sensitivity and negative predictive value (NPV) of MODEL-1 and MODEL-2. Finally, we used the SHAP (SHapley Additive exPlanations) method to provide insights into the model’s outcome or prediction. MODEL-2 (AUROC: 0.822; 95% confidence interval [CI] 0.783–0.856), liked MODEL-1 (AUROC: 0.822; 95% CI 0.784–0.856), could well predict the risk of SBP in cirrhotic ascites patients. The 6 most influential predictive variables were total protein, C-reactive protein, prothrombin activity, cholinesterase, lymphocyte ratio and apolipoprotein A1. For binary classifier, the sensitivity and NPV of MODEL-1 were 0.894 and 0.885, respectively, while for MODEL-2 they were 0.927 and 0.904, respectively. We applied CatBoost algorithm to establish a practical and explainable prediction model for risk of SBP in cirrhotic patients with ascites. We also identified 6 important variables closely related to the occurrence of SBP.

S3631 The Milky Way

Introduction: Chylous ascites is a rare clinical finding indicative of peritoneal fluid containing lymphatic drainage. It is characterized by having a milky appearance that is rich in triglycerides, surpassing 110 mg/dL. This condition develops after disruption of the lymphatic system, usually secondary to trauma after abdominal surgery, malignancy, or cirrhosis. Chylous ascites accounts for less than 0.5% of cases of ascites in cirrhotic patients, presenting as progressive and painless abdominal distention. Case Description/Methods: Case of a 71 year-old male with history of cirrhosis due to hepatitis C on remission treated with elbasvir/grazoprevir, hypertension and end stage renal disease (ESRD) on hemodialysis (HD) who came to our institution after developing worsening abdominal distention with associated shortness of breath since 2 weeks prior. He denied fever, chills, cough, palpitations, chest pain, abdominal pain, hematemesis, hematochezia, or melena. Vitals signs were stable and physical exam was remarkable for a distended, tense and painless abdomen. Laboratories showed leukocytes in 7.8 x 103/uL, normocytic-normochromic anemia of 9.0 g/dL and platelets in 262 x103/ uL. Chemistry showed renal function consistent with his ESRD, without electrolyte disturbances. SGPT at 13 U/L and SGOT at 22 U/L. Anti-HBS, HBS ag and HIV ag/ab combo is nonreactive. Abd/pelvic CT scan revealed a nodular liver contour with hypertrophic changes of the left lobe compatible with chronic hepatocellular disease. The patient’s symptoms and findings were consistent with decompensated liver disease with tension ascites, for which a large-volume paracentesis was performed, removing 9L of white-milky fluid with subsequent placement of 50 g of IV albumin. The calculated serum-ascites albumin gradient (SAAG) was 2.4 g/dL consistent with portal hypertension. Ascitic fluid analysis revealed 40 cell count, 2 neutrophils, 916 mg/dL triglycerides and 90 mg/dL cholesterol, indicative of chylous ascites. Discussion: Abdominal paracentesis and analysis of the ascitic fluid are essential for the evaluation and management of chylous ascites. Management should focus on treatment of the underlying disease; however supportive measures may alleviate symptoms. These measures may include repeated paracentesis, diuretic therapy, salt and water restriction and dietary measures. It is imperative to be aware of this unusual manifestation, requiring prompt evaluation and appropriate management of the underlying pathology.Figure 1.: Ascitic fluid obtained after performing abdominal paracentesis.

Evaluation of serum and ascitic monocyte chemotactic protein-1 level in patients with and without spontaneous bacterial peritonitis

Objectives To evaluate the diagnostic value of serum and ascitic fluid monocyte chemotactic protein-1 (MCP-1) level in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP). Background SBP is one of the potential life-threatening complications in ascitic cirrhotic patients, with a mortality rate ranging between 30 and 50%. Patients and methods This study was conducted on 40 patients with cirrhotic ascites with and without SBP admitted to Internal Medicine Department, Menoufia University Hospital, and El Sahel Teaching Hospital from October 2017 to October 2018. All patients included in this study were divided into two groups as follows: group I included 10 ascitic patients without SBP, and group II included 30 ascitic patients with SBP. Results Mean level of MCP-1 was significantly higher in SBP group than non-SBP group. For MCP-1, the cutoff point that gives an area of 91% was 122.5 ng/ml, with sensitivity of 86% and of specificity 95%. For serum MCP-1, the cutoff point that gives an area of 91% was 100.5 ng/ml, with of sensitivity 85% and specificity of 94%. For polymorphonuclear cell count, the cutoff point that gives an area of 78% was 62.5 cell/cm3, with a sensitivity of 100% and specificity of 41%. Conclusion MCP-1 is a good diagnostic marker for SBP with its high sensitivity (86.7%) and specificity (95.4%) with high reliability (91%) in patients with SBP. Moreover, MCP-1 is a good prognostic marker owing to its positive relation with the severity of liver disease, which is indicated by high model for end-stage liver disease scores.

Diagnostic usefulness of the spot urine sodium/potassium ratio in cirrhotic patients with ascites.

Background and aimsThe low-salt diet is considered important for control of ascites in cirrhotic patients. To validate whether the spot urine sodium (Na)/potassium (K) ratio could replace 24-h urine Na (uNa) excretion in assessing low-salt diet compliance.MethodsWe prospectively studied 175 patients. 24-h urine collection and spot urine collection were performed. Subsequently, 24-h uNa, urine creatinine (uCr), and spot urine Na and K were assessed. A complete urine collection was confirmed based on 24-h uCr excretion levels of 15mg/kg/day for men and 10mg/kg/day for women. The area under the receiver operating characteristic (AUROC) curve analysis was performed to evaluate the feasibility of spot urine Na/K ratio in predicting 24-h uNa greater than 78mmol/day.ResultsOut of 175 patients, 24-h urine samples were completely collected in 57 patients only. Moreover, urine samples were not completely collected in 118 patients because their 24-h uCr excretion level was less than the established criteria. In complete urine collection group, AUROC curve for spot urine Na/K ratio in predicting 24-h uNa greater than 78mmol/day was 0.874±0.051 (P<0.001). In the incomplete urine collection group, the AUROC was 0.832±0.039 (P<0.001). In complete urine collection group, the classical cutoff value greater than 1.0 of spot urine Na/K ratio showed 90.9% sensitivity and 56.0% specificity.ConclusionsThe spot urine Na/K ratio reflects 24-h uNa, but the AUROC value obtained in this study is lower than that of a previous study. Considered the large number of patients with incomplete urine collection, validating 24-h complete urine collection criteria is necessary.