Current approaches to the management of patients with cirrhotic ascites

Garbuzenko, Dmitry Victorovich; Arefyev, Nikolay Olegovich

doi:10.3748/wjg.v25.i28.3738

Cited by 27 publications

(39 citation statements)

References 119 publications

(120 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A retrospective cohort study of consecutive US veterans, ages 20–80 years, with cirrhosis and a diagnosis of SBP during hospitalization over a 13‐year period (1 July 2005 to 1 July 2018) was performed at this single VA Medical Center. Inclusion criteria were: (i) diagnosis of cirrhosis by ICD‐9 and ICD‐10 codes or index history and physical exam (H&P) note, with ascites noted on index H&P exam; (ii) SBP based on peritoneal fluid analysis (ascitic fluid absolute neutrophil count [ANC] of ≥250 cells per mm 3 ); and (iii) admission for cirrhosis‐related complications (bleed, encephalopathy, worsening ascites, liver mass, or portal vein thrombosis) or nonspecific symptoms, including fever, tachycardia, leukocytosis, and hypotension. Exclusion criteria included: (i) admission for a noncirrhosis‐related etiology (e.g.…”

Section: Methodsmentioning

confidence: 99%

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

et al. 2019

View full text Add to dashboard Cite

Background Spontaneous bacterial peritonitis (SBP) is common in hospitalized cirrhotic patients with ascites and carries high mortality. This study aimed to determine whether early diagnostic paracentesis (EDP) <12 h of hospitalization conveys an intermediate‐term (6‐month) survival benefit in cirrhotic patients diagnosed with SBP. Methods Consecutive US veterans with cirrhosis diagnosed with SBP over 13 years at a single VA medical center were reviewed retrospectively. Kaplan‐Meyer analyses assessed the effects of EDP on survival. Results A total of 79 cirrhotic patients were diagnosed with SBP (61.8 ± 8.8 years, n = 77 male, n = 52 [66.8%] Caucasian, n = 23 [29.1%] African‐American). Underlying liver diseases included hepatitis c viral infection (HCV) (17.5%), alcohol (28.6%), alcohol and HCV (30.1%), and cryptogenic/metabolic (15.9%). Median baseline model for end‐stage liver disease (MELD) was 12 (range 6–34), and median MELD at presentation was 18. Seven subjects had a history of hepatocellular carcinoma (11.1%), and 26 (41.3%) presented with sepsis. Thirty‐three (52.4%) subjects died within 6 months after the SBP admission. Of the subjects, 41 (65.1%) underwent EDP, of which 23 (56.0%) survived at least 6 months, compared to only 7 of the 22 patients (31.8%) undergoing paracentesis >12 h from presentation (P = 0.057). The maximal benefit of EDP on survival was observed beyond days 14 and 30; at these time points, no statistical difference in mortality was discernable (P = 0.55 and 0.71). In a multivariate model including age, MELD at admission, hepatocellular cancer, and sepsis criteria, EDP (p 0.034) positively impacted patient survival at 6 months. Conclusions EDP is associated with improved 6‐month mortality in cirrhotic patients with ascites. In this veteran cohort, EDP was as important as MELD as a predictor of intermediate‐term survival.

show abstract

Section: Methodsmentioning

confidence: 99%

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

et al. 2019

View full text Add to dashboard Cite

show abstract

“…1 Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimal invasive treatment may improve the quality of life and increase the survival rate. 2 The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy.3 Cirrhosis is the most common cause of ascites in the Western world (75%), followed by peritoneal malignancy (12%), heart failure (5%), and peritoneal tuberculosis (2%). 3 Cardiomyopathies are not very common diseases, but may cause severe complications, making a substantial contribution to maternal morbidity and mortality during pregnancy, in the immediate peripartum period, and up to months later.…”

Section: Introductionmentioning

confidence: 99%

Ascites in peripartum cardiomyopathy: case report

Dana¹,

Susanto²,

Suryana³

2021

Int J Adv Med

View full text Add to dashboard Cite

Ascites is the abnormal accumulation of excess fluid in peritoneal cavity.1 Normally, peritoneal cavity contains 25–50 mL of ascitic fluid, which allows for the movement of bowel loops past one other and helps hydrate serousal surfaces. Cirrhosis is the most common cause of ascites in the Western world (75%), followed by peritoneal malignancy (12%), heart failure (5%) (include peripartum cardiomyopathy), and peritoneal tuberculosis (2%). A 19-years-old woman diagnosed with peripartum cardiomyopathy. She came with chest pain and increased of her abdominal perimeter since 6 month ago, a month after she got cesarean delivery. She was given high protein and low sodium diet, water restriction, treated with furosemide 40 mg, spironolactone 25 mg, and abdominal paracentesis with total 1500 cc of yellowish ascites fluid was evacuated. Early detection is required in this case to ensure effective management without any complications. Treatment depends upon the cause of the ascites. Dietary sodium restriction and diuretics remains the first line therapy for its management. The use of diuretics needs close monitoring and follow up, including weight loss, electrolytes, and patient’s condition daily.

show abstract

“…diuretic administration, peritoneal ports, and transhepatic portosystemic shunting (TIPS)), these interventions have been shown to offer limited palliation benefits, while conveying risk for infection and/or potentially further decreasing quality of life. 2 -6 Alternatively, ultrasound-guided palliative paracentesis is a demonstrated safe and effective method for the management of patients with symptomatic ascites, but traditionally requires the patient be transferred to an acute care setting equipped to perform the procedure (i.e. emergency department (ED), inpatient unit, or outpatient interventional radiology (IR) suite).…”

Section: Introductionmentioning

confidence: 99%

Palliative Paracentesis in the Home Setting: A Case Series

Ota

Schultz

Segaline

2020

Am J Hosp Palliat Care

View full text Add to dashboard Cite

Background: Management of ascites-related symptoms in home hospice and palliative care patients can be challenging. Ultrasound-guided paracentesis is a standard intervention for this indication, but generally requires transfer to a hospital or outpatient interventional-radiology (IR) setting; thus, such interventions are often not practical or attainable for home hospice and palliative care patients. Objective: To describe a mobile, in-home service that provides home-based palliative paracentesis (HBPP) as an interventional palliative option for patients with distressing symptoms related to ascites. Design: Retrospective case series. Setting/Subjects: Thirty patients with ascites, confirmed by portable bedside ultrasound, who underwent HBPP at their residence. Results: Thirty-three patients were referred for HBPP for symptomatic abdominal distention from March 1, 2019 to March 1, 2020. Thirty (91%) patients had ultrasound-confirmed ascites and received HBPP. All 30, verbalized appreciable symptom relief post-intervention. There were no reported post-procedural complications. Conclusion: Home-based palliative paracentesis is a safe, effective, and convenient intervention for hospice and palliative care patients with symptomatic ascites.

show abstract

Current approaches to the management of patients with cirrhotic ascites

Cited by 27 publications

References 119 publications

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

Ascites in peripartum cardiomyopathy: case report

Palliative Paracentesis in the Home Setting: A Case Series

Contact Info

Product

Resources

About