Introduction: Decompensated cirrhosis is a common presentation in patients requiring inpatient care. According to 2012 guidelines from AASLD, paracentesis should be performed in patients admitted to the hospital with ascites regardless of the reason for admission. This retrospective study hypothesizes that evening admission will be positively associated with delay in paracentesis (defined as 12-hour paracentesis delay) and non-optimal treatment choice of paracentesis being done after antibiotic administration. Methods: 138 patients admitted with ascites secondary to cirrhosis between March 2017 and February 2021 were included. Variables studied included hospital admission of day (7 AM to 6:59 PM) versus evening (7 PM to 6:59 AM), paracentesis delay (Y/N), and whether paracentesis was performed before antibiotic administration, after antibiotic administration, or not performed. IBM SPSS Statistics Version 28 and Stata SE Version 17 were used for the analyses. P-values were two-tailed with alpha level for significance at p, 0.05. Results: We found that of all patients, 39% had paracentesis after antibiotic administration, 43% did not have paracentesis at all and 37% had delayed paracentesis. During evening admission, fewer patients were likely to have paracentesis before antibiotic administration (p50.096). In analyses comparing paracentesis after antibiotic administration with paracenteses before antibiotic administration, evening admission was significantly associated with an increased relative risk for paracentesis after antibiotic administration (p 0.046). Also, when combining the groups of paracenteses after antibiotic administration with paracentesis not done, evening admission was associated with the lowest frequency of paracentesis before antibiotic administration (p50.03). Conclusion:The benefits of early paracentesis outweigh the risks of infection or bleeding associated with the procedure. Performing paracentesis has a greater diagnostic yield if done prior to antibiotic administration, as even a 6-hour delay can decrease infection detection rate. We found that overall, fewer patients with ascites received paracentesis, and evening admission was associated with suboptimal management with paracentesis done after antibiotic administration. Based on the above findings, there is room for improvement in educating all clinicians, particularly those working during the evening shift, on the importance of performing paracentesis prior to antibiotic administration.
INTRODUCTION: Selective Internal Radiation Therapy (SIRT) with Yttrium 90 using glass beads (Theraspheres) is increasingly being used for the treatment of unresectable Hepatocellular carcinoma approved by the FDA as a Humanitarian Device (HUD exemption). We are presenting data on 70 patients at our center (out of 130) that have undergone this procedure successfully and reporting their outcomes/survival/tolerability and factors impacting survival. METHODS: We retrospectively analyzed the charts of 70 patients that underwent SIRT with Theraspheres at our institution from jan 1, 2014 to jan 1, 2019.We performed descriptive statistics on these patients using SAS. RESULTS: Demographically 46/70 patients were male. 50% were caucasian, 20% African american and 16% Hispanic. The median age was 64.5 years. In our cohort, Alcohol and HCV infection were responsible etiologies in 77% of all the cancers. 17% patients had NASH as the etiology. 43% of patients had a solitary tumor while 30% had 2 tumors and the remaining 3 or more treatable lesions. The median total tumor diameter was 5.2 cm. 37% of the tumors were bilobar. 39% patients had main or branched portal vein thrombosis (PVT). 65% of the patients had Child's Pugh A cirrhosis while 31% were CPB. Median MELD score was 8. BCLC subdivision was as follows - A (31%), B (41%), C 24%) and D(4%). 67% patients underwent single treatment while 28% patients had 2 treatments done.The dose ranged from 10–110 mci with 50 mci being the median dose. In terms of tumor response, 54% patients had complete response (CR) while 20% had partial response (PR) and 16% had progressive disease (PD) per modified RECIST criteria. Adverse events requiring an intervention were seen in 10% patients.Overall survival is shown in graph below. Mean survival was 14.6 months CONCLUSION: In our analysis, SIRT with theraspheres is a safe effective modality of treating patients with advanced HCC even in the setting of multifocal disease with 40% patients having portal vein thrombosis. The median survival was over 12 months with CR seen in 57% patients. Further analysis of our complete data will shed more light on these calculations.
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