We present, to our knowledge, the first multicenter study examining outcomes related to IPC use in HH. Ten percent infection risk and 2.5% mortality were identified. IPC placement may be a reasonable clinical option for patients with refractory HH, but it is associated with significant adverse events in this morbid population.
Background: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. Objectives: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. Methods: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. Results: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5–14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03–1.36, p = 0.012). Conclusions: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.
Short-term medical trips with a recurrent presence in a community may improve control of hypertension and other NCDs in developing nations. Further research into the impact that short-term medical trips may have on NCDs is needed.
PURPOSE: Hepatic hydrothorax refractory to salt/fluid restriction and diuretic therapy happens in 21-26% of cirrhotic patients in whom trans-jugular intrahepatic porto-systemic shunt (TIPS) and liver transplantation are not always available or indicated. These patients are therefore offered repeated thoracenteses for symptom control but the risk profile for such a management strategy remains unclear. In this retrospective study, we report on the complications of repeated thoracenteses in cirrhotic patients with hepatic hydrothorax. METHODS: In this retrospective cohort study, using chart reviews, we included patients aged 18 or older who received thoracentesis at a single center between 2010-2015. Collected data included patient demographics, comorbidities, number of thoracentesis, site and volume of fluid removed. When available, we included pleural fluid analysis, basic chemistries, liver function profile, coagulation profile and MELD scores prior to each thoracentesis. Complications associated with each procedure including the presence of pneumothorax, hemothorax, cardiovascular compromise, re-expansion pulmonary edema and death were individually recorded. RESULTS: 182 patients with at least one thoracentesis were included in the study. Thoracenteses were performed on 82 patients with hepatic. 274 procedures were recorded in the hepatic hydrothorax group with each patient having at least 1 and up to 16 thoracenteses. 100 patients who underwent thoracentesis (100 procedures) for reasons other than hepatic hydrothorax were included as control group. Using a Fisher's Exact Test, we identified a significantly higher complication rate in hepatic hydrothorax vs control group (7.3% vs. 2% respectively, p ¼ 0.0381). When the complication rate was assessed against the number of repeated thoracenteses within the hepatic hydrothorax group, we identified that the cumulative risk increased with sequential thoracenteses. Using a logistic regression model we showed that having an immediate previous complication significantly increases the risk of having another complication by almost 21 fold (OR¼20.99, p<0.0001) and having more than 1 previous complication (but not necessarily an immediate previous complication) increases the risk of complication by at least 3 fold (OR¼3.16, p¼0.0006). There was a trend towards lower platelets, higher INR, BUN and MELD score with complications, but these were not significant (p ¼ 0.254, 0.797, 0.554, and 0.379 respectively). CONCLUSIONS: Our study shows that patients with hepatic hydrothorax who undergo repeated thoracenteses have a higher complication rate compared to control group. Presence of previous complications with thoracentesis in this patient population significantly increases the chance of complications with the next thoracentesis. CLINICAL IMPLICATIONS: Our study shows that patients with hepatic hydrothorax have a higher thoracentesis-associated complication rate. Furthermore, this risk increases with a positive thoracentesis complication history. Providers who take care of this ...
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