Clinical Features of Refractory Ascites in Outpatients

Abstract

OBJECTIVES:To present the clinical features and outcomes of outpatients who suffer from refractory ascites.METHODS:This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month.RESULTS:The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R) and 11 non-refractory ascites (NR)]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034). The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively). Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262).CONCLUSION:Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes.

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

“…The International Club of Ascitis (ICA) defined refractory ascites (RA) in the presence of ascites that cannot be mobilized or that recurred shortly (<4 weeks) after large volume paracentesis (LVP), sodium restriction (saltrestricted diet of less than 5.2 g of salt/day) and intensive diuretic therapy (spironolactone up to 400 mg/day and furosemide up to 160 mg/day) for at least on week (7) or in the presence of diureticintractable ascites due to the occur rence of adverse effects such as hepatic encephalopathy (HE), acute kidney injury (AKI), hyponatremia, hypokalemia, hyperkalemia and intolerable muscle cramps (7) . Several challenging complications are commonly seen in patients with RA, such as AKI and HRS, dilutional hyponatremia, hepatic hydrothorax (HH), incarcerated umbilical hernias, spontaneous bacterial peritonitis (SBP) and severe malnutrition (8,9) . The sixmonth survival of patients with RA is estimated as 50% (10) .…”

Diagnosis of follicular lymphoma by laparoscopy: A case report

“…Common causes include cirrhosis, tuberculous peritonitis, and malignant tumors in the abdominal cavity. Cases with intractable ascites and/or ascites due to unknown reasons often have poor clinical outcomes or recurrent attacks, causing pain and increased medical burden to patients[2,3]. For clinically unexplained ascites, it is difficult to identify the cause relying only on clinical symptoms, serology, ascites puncture, cytology, ascites culture, imaging examination.…”

LVP vs TIPS for Refractory Ascites: Where Do We Stand?

“…6 Although LVP has a longer history than novel TIPS intervention, both procedures may serve as a bridge to liver transplantation. 7 Unfortunately most patients with refractory ascites do not attain a high enough Model for End-Stage Liver Disease (MELD) score to justify liver transplantation. Although LVP and TIPS can manage these patients clinically, there are subtle but salient differences between the two therapies.…”