Pleural Effusions Identified by Point-of-Care Ultrasound Predict Poor Outcomes in Decompensated Cirrhosis

Rendón-Ramírez, Erick Joel; González-Villarreal, Marusia; Muñoz-Espinoza, Linda; Colunga‐Pedraza, Perla R.; Moreno, Juan Francisco Rodriguez; Salinas-Chapa, Matías; Mercado-Longoría, Roberto; Treviño-García, Karla Belén; Cazares-Rendón, Erika; Porcel, José M.

doi:10.1016/j.ultrasmedbio.2021.07.006

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…Finally, in a Mexican study, 50% of 116 consecutive inpatients with decompensated cirrhosis had pleural effusions by bedside thoracic ultrasound. 90 The identification of pleural effusions doubled the mortality at 1 year (39.7 vs. 20.7%) and the length of hospitalization (10 vs. 5.5 days). Patients with both pleural effusions and Child–Pugh C stage exhibited the poorest outcomes (median survival of 70 vs. 317 days).…”

Section: Management Of Hepatic Hydrothoraxmentioning

confidence: 97%

“…The significant mortality associated with HH has been supported by several reports. [87][88][89][90] In a Taiwanese nationwide study, the 1-month, 3-month, 1-year, and 3-year mortality rates of 3,487 cirrhotic patients with PE requiring drainage during hospitalization were 20.1, 40.2, 59.1, and 75.9%, respectively. 87 A retrospective study of 763 consecutive patients with cirrhosis and ascites admitted to a single center compared the long-term survival of those who also had HH (100, 13.1%) with those who did not.…”

Section: Management Of Hepatic Hydrothoraxmentioning

confidence: 99%

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Nonmalignant Pleural Effusions

Porcel

2022

Semin Respir Crit Care Med

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Although the potential causes of nonmalignant pleural effusions are many, the management of a few, including complicated pleural infections and refractory heart failure and hepatic hydrothoraces, can be challenging and requires the assistance of interventional pulmonologists. A pragmatic approach to complicated parapneumonic effusions or empyemas is the insertion of a small-bore chest tube (e.g., 14–16 Fr) through which fibrinolytics (e.g., urokinase and alteplase) and DNase are administered in combination. Therapeutic thoracenteses are usually reserved for small to moderate effusions that are expected to be completely aspirated at a single time, whereas video-assisted thoracic surgery should be considered after failure of intrapleural enzyme therapy. Refractory cardiac and liver-induced pleural effusions portend a poor prognosis. In cases of heart failure–related effusions, therapeutic thoracentesis is the first-line palliative therapy. However, if it is frequently needed, an indwelling pleural catheter (IPC) is recommended. In patients with hepatic hydrothorax, repeated therapeutic thoracenteses are commonly performed while a multidisciplinary decision on the most appropriate definitive management is taken. The percutaneous creation of a portosystemic shunt may be used as a bridge to liver transplantation or as a potential definitive therapy in nontransplant candidates. In general, an IPC should be avoided because of the high risk of complications, particularly infections, that may jeopardize candidacy for liver transplantation. Even so, in noncandidates for liver transplant or surgical correction of diaphragmatic defects, IPC is a therapeutic option as valid as serial thoracenteses.

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Section: Management Of Hepatic Hydrothoraxmentioning

confidence: 97%

Section: Management Of Hepatic Hydrothoraxmentioning

confidence: 99%

Nonmalignant Pleural Effusions

Porcel

2022

Semin Respir Crit Care Med

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“…In a study of 116 patients with decompensated cirrhosis, anteroposterior chest X-rays missed about 40% of pleural effusions identified by LUS. Interestingly, detecting effusions with LUS was linked to a longer hospital stay (10 d vs 5.5 d, P < 0.001) and doubled mortality (39.7% vs 20.7%, P = 0.021)[ 65 ].…”

Section: Evaluation Of Congestion Using Pocusmentioning

confidence: 99%

Sound waves and solutions: Point-of-care ultrasonography for acute kidney injury in cirrhosis

Aguirre-Villarreal,

Leal-Villarreal,

García-Juárez

et al. 2024

World J Crit Care Med

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This article delves into the intricate challenges of acute kidney injury (AKI) in cirrhosis, a condition fraught with high morbidity and mortality. The complexities arise from distinguishing between various causes of AKI, particularly hemodynamic AKI, in cirrhotic patients, who experience hemodynamic changes due to portal hypertension. The term "hepatocardiorenal syndrome" is introduced to encapsulate the intricate interplay among the liver, heart, and kidneys. The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis, unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function. The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed, highlighting potential risks and variable patient responses. We advocate for a nuanced algorithm for AKI evaluation in cirrhosis, prominently featuring point-of-care ultrasonography (POCUS). POCUS applications encompass assessing fluid tolerance, detecting venous congestion, and evaluating cardiac function.

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“…Lung POCUS is also effective in identifying pleural effusion, appearing as an anechoic (black) area in the dependent zones Figure 3 . In one study, antero-posterior chest radiographs failed to recognize approximately 40% of effusions visible on ultrasound in patients with cirrhosis[ 22 ]. Phrases like "discontinue fluids if respiratory status worsens" or "oxygen saturation is OK, continue fluids" are commonly seen in the physicians’ notes.…”

Section: Basic Pocusmentioning

confidence: 99%

Point-of-care ultrasonography in cirrhosis-related acute kidney injury: How I do it

Koratala

2024

World J Crit Care Med

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Discerning the etiology of acute kidney injury (AKI) in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes. The conventional approach of empiric albumin administration for suspected volume depletion may inadvertently lead to fluid overload. In the recent past, point-of-care ultrasonography (POCUS) has emerged as a valuable adjunct to clinical assessment, offering advantages in terms of diagnostic accuracy, rapidity, cost-effectiveness, and patient satisfaction. This review provides insights into the strategic use of POCUS in evaluating cirrhotic patients with AKI. The review distinguishes basic and advanced POCUS, emphasizing a 5-point basic POCUS protocol for efficient assessment. This protocol includes evaluations of the kidneys and urinary bladder for obstructive nephropathy, lung ultrasound for detecting extravascular lung water, inferior vena cava (IVC) ultrasound for estimating right atrial pressure, internal jugular vein ultrasound as an alternative to IVC assessment, and focused cardiac ultrasound for assessing left ventricular (LV) systolic function and identifying potential causes of a plethoric IVC. Advanced POCUS delves into additional Doppler parameters, including stroke volume and cardiac output, LV filling pressures and venous congestion assessment to diagnose or prevent iatrogenic fluid overload. POCUS, when employed judiciously, enhances the diagnostic precision in evaluating AKI in cirrhotic patients, guiding appropriate therapeutic interventions, and minimizing the risk of fluid-related complications.

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Pleural Effusions Identified by Point-of-Care Ultrasound Predict Poor Outcomes in Decompensated Cirrhosis

Cited by 6 publications

References 15 publications

Nonmalignant Pleural Effusions

Nonmalignant Pleural Effusions

Sound waves and solutions: Point-of-care ultrasonography for acute kidney injury in cirrhosis

Point-of-care ultrasonography in cirrhosis-related acute kidney injury: How I do it

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