Management of hepatic hydrothorax and effect on length of stay, mortality, cost, and 30‐day hospital readmission

Sobotka, Lindsay; Spitzer, Carleen; Hinton, Alice; Michaels, Anthony; Hanje, A. James; Mumtaz, Khalid; Conteh, Lanla

doi:10.1111/jgh.14842

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…However, a single centre retrospective review of patients undergoing thoracentesis showed the cumulative risk of complications increased with sequential thoracenteses ( 17 ), with increased risk of haemothorax with thrombocytopenia and higher MELD scores (Model for End-Stage Liver Disease which stratifies severity of liver disease). Repeated thoracentesis has also been shown to be associated with increased hospital cost and longer length of stay ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

et al. 2021

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Introduction: Liver transplantation is the treatment of choice for decompensated liver disease, and by extension for hepatic hydrothorax. Persistent pleural effusions make it challenging for patients to maintain physiological fitness for transplantation. Indwelling pleural catheters (IPCs) provide controlled pleural fluid removal, including peri-operatively. The immune dysfunction of cirrhosis heightens susceptibility to bacterial infection and concerns exist regarding the sepsis potential from a tunnelled drain.Method: Six patients were identified who underwent IPC insertion for hepatic hydrothorax before successful liver transplantation, between November 2016 and November 2017.Results: All patients had recurrent transudative right sided pleural effusions. Mean age was 49 years (range 24–64) and mean United Kingdom Model for End-Stage Liver Disease score was 58. Four patients required correction of coagulopathy before insertion. There were no complications secondary to bleeding. Three patients were taught self-drainage at home of up to 1 litre (L) daily. A protocol was developed to ensure weekly review, pleural fluid culture and drainage of larger volumes in hospital. For every 2–3 L of pleural fluid drained, 100 mls of 20% Human Albumin Solution (HAS) was administered. On average an IPC was in situ for 58 days before surgery and drained 19 L of fluid in hospital. There was a small increase in average BMI (0.2) and serum albumin (2.1 g/L) at transplantation. There was one episode of stage one acute kidney injury secondary to high volume drainage. No further ascitic or pleural procedures were needed while an IPC was in situ. One thoracentesis was required after IPC removal. On average IPCs remained in situ for 7 days post transplantation and drained a further 2 L of fluid. Pleural fluid sampling was acquired on 92% of drainages in hospital. Of 44 fluid cultures, 2 cultured bacteria. Two patients had their IPCs and all other lines removed post transplantation due to suspected infection.Conclusion: Our case series describes a novel protocol and successful use of IPCs in the management of refractory hepatic hydrothorax as a bridge to liver transplantation. The protocol includes albumin replacement during pleural drainage, regular clinical review and culture of pleural fluid, with the option of self-drainage at home.

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Section: Discussionmentioning

confidence: 99%

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

et al. 2021

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“…97 Data from the U.S. National Inpatient Sample from 2003 to 2013 (n ¼ 37,443) showed that 72% (26,889) of patients had a thoracentesis. 100 Thoracentesis was independently associated with a longer length of stay (β-coefficient: 4.56 days, p < 0.001) and higher cost per admission (β-coefficient: $9,449, p ¼ 0.001). 100…”

Section: Hepatic Hydrothoraxmentioning

confidence: 94%

“…100 Thoracentesis was independently associated with a longer length of stay (β-coefficient: 4.56 days, p < 0.001) and higher cost per admission (β-coefficient: $9,449, p ¼ 0.001). 100…”

Section: Hepatic Hydrothoraxmentioning

confidence: 94%

The Global Burden of Pleural Diseases

Vakil

Taghizadeh

Tremblay

2023

Semin Respir Crit Care Med

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Pleural diseases include a spectrum of disorders broadly categorized into pneumothorax and pleural effusion. They often cause pain, breathlessness, cough, and reduced quality of life. The global burden of diseases reflects regional differences in conditions and exposures associated with pleural disease, such as smoking, pneumonia, tuberculosis, asbestos, cancer, and organ failure. Disease burden in high-income countries is overrepresented given the availability of data and disease burden in lower-income countries is likely underestimated. In the United States, in 2016, there were 42,215 treat-and-discharge visits to the emergency room for pleural diseases and an additional 361,270 hospitalizations, resulting in a national cost of $10.1 billion.

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“…Patients were also excluded if they did not have at least 12 months of follow up after initiation of a CFTR modulator and/or ursodiol, periods of non-continuous drug claims enrollment, and no prescription coverage for any of the enrollment period. Diagnostic codes for each of these inclusion and exclusion criteria have been widely used in previous publications[ 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

Cystic fibrosis patients on cystic fibrosis transmembrane conductance regulator modulators have a reduced incidence of cirrhosis

Ramsey¹,

Wellner²,

Porter³

et al. 2022

WJH

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BACKGROUND Cystic fibrosis transmembrane conductance regulator (CFTR) modulators significantly improve pulmonary function in patients with cystic fibrosis (CF) but the effect on hepatobiliary outcomes remains unknown. We hypothesized that CF patients on CFTR modulators would have a decreased incidence of cirrhosis compared to patients not on CFTR modulators or on ursodiol. AIM To investigate the effect of CFTR modulators on the development of cirrhosis in patients with CF. METHODS A retrospective analysis was performed using Truven MarketScan from January 2012 through December 2017 including all patients with a diagnosis of CF. Patients were excluded if they underwent a liver transplantation or if they had other etiologies of liver disease including viral hepatitis or alcohol use. Subjects were grouped by use of CFTR modulators, ursodiol, dual therapy, or no therapy. The primary outcome was development of cirrhosis. Kaplan-Meier curves estimated the incidence of cirrhosis and log-rank tests compared incidence curves between treatment groups. RESULTS A total of 7201 patients were included, of which 955 (12.6%) used a CFTR modulator, 529 (7.0%) used ursodiol, 105 (1.4%) used combination therapy, and 5612 (74.3%) used neither therapy. The incidence of cirrhosis was 0.1% at 1 year and 0.7% at 4 years in untreated patients, 5.9% and 10.1% in the Ursodiol group, and 1.0% and 1.0% in patients who received both therapies. No patient treated with CFTR modulators alone developed cirrhosis. Patients on CFTR modulators alone had lower cirrhosis incidence than untreated patients ( P = 0.05), patients on Ursodiol ( P < 0.001), and patients on dual therapy ( P = 0.003). The highest incidence of cirrhosis was found among patients treated with Ursodiol alone, compared to untreated patients ( P < 0.001) or patients on Ursodiol and CFTR modulators ( P = 0.01). CONCLUSION CFTR modulators are associated with a reduction in the incidence of cirrhosis compared to other therapies in patients with CF.

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Management of hepatic hydrothorax and effect on length of stay, mortality, cost, and 30‐day hospital readmission

Cited by 11 publications

References 29 publications

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation

The Global Burden of Pleural Diseases

Cystic fibrosis patients on cystic fibrosis transmembrane conductance regulator modulators have a reduced incidence of cirrhosis

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