Impact on survival of decompensated liver cirrhosis and large volume paracentesis: a retrospective cohort

Introduction and Objectives

Ascites is the most common complication of cirrhosis. Its presence represents a 40% mortality at 2 years. The objective of this study was to determine survival in patients with decompensated liver cirrhosis due to ascites undergoing large-volume paracentesis.

Materials and Patients

A retrospective, cross-sectional, observational, analytical study was conducted. Patients with liver cirrhosis over 18 years of age of both sexes, of any etiology, treated at Centro Médico Nacional 20 de Noviembre between January 2013 and June 2023, who underwent large volume paracentesis, were selected and matched 2:1 with controls who did not require high volume paracentesis, adjusted for disease severity, age, sex, and Child-Pugh stage. Exclusion criteria were pregnancy or lactation, under 18 years of age, and ascites of a different origin than chronic liver disease. The data was extracted from clinical records.

Results

A total of 226 patients were analyzed, 61.9% women (n=140) and 38.1% men (n=86). The average age was 64.28 years (SD=13.33). The minimum age was 19 years and maximum was 91 years. The most frequent etiology was hepatic steatosis in 34.07% (n=77), followed by hepatitis C in 19.91% (n=45), alcoholism in 12.38% (n=28), autoimmune hepatitis in 10.17% (n=23). The distribution of patients by Child-Pugh classification was B in 69% (n=156) and C in 31% (n=70). The average MELD-NA score was 16.93 (SD=7.10). The main comorbidities were 36.7% (n=83) type 2 diabetes mellitus, 24.8% (n=56) systemic arterial hypertension, 15% (n=34) chronic kidney disease, and 16.4% (n=37) obesity.

Out the 226 patients with liver cirrhosis with ascites, 33.2% (n=75) underwent large volume paracentesis while 66.8% (n=151) underwent paracentesis less than 5 liters. The mortality of patients undergoing large volume paracentesis was 32% compared to 20.5% RR 1.55, IC 95% (0.98-2.45) of patients who did not. In bivariate analysis by sex, there were no statistically significant differences in mortality. Stratified analysis by nutritional status with body mass index did not show differences in mortality in patients undergoing large volume paracentesis.

Conclusions

No statistically significant differences in mortality were observed between patients undergoing large volume paracentesis and those who did not. It is important to consider that factors other than paracentesis volume may influence patient survival.

Ethical statement: This study adheres to ethical principles in clinical research involving human subjects and presents no risk to the population under investigation as only information obtained from clinical records will be evaluated.

Declaration of interests: None.

Funding: All human and material resources were provided by Centro Médico Nacional 20 de Noviembre, ISSSTE.

Table 1.

Demographic Characteristics

	LARGE VOLUME PARACENTESIS (n = 75)	NO LARGE VOLUME PARACENTESIS (n = 151)	P VALUE
AGE, MEAN	63.15	64.85	0.35
FEMALE (%)	41 (54.66)	99 (65.56)	0.11
MALE (%)	34 (45.33)	52 (33.77)	0.11
CHILD-PUGH (%)
B	44 (58.66)	112 (74.17)	0.01
C	31 (41.33)	39 (25.82)
MELD-NA, MEAN	19.92	15.45	0.00
HEPATOPATHY ETIOLOGY
HEPATIC STEATOSIS (%)	24 (32)	53 (35.09)	0.04
HEPATITIS C INFECTION (%)	9 (12)	36 (23.84)	0.04
ALCOHOL (%)	11 (14.66)	17 (11.25)	0.04
HEPATITIS B INFECTION (%)	0 (0)	2 (1.32)	0.04
AUTOIMMUNE HEPATITIS (%)	9 (12)	14 (9.27)	0.04
CBP (%)	6 (8)	15 (9.93)	0.04
CEP (%)	0 (0)	2 (1.32)	0.04
IDIOPATHIC (%)	11 (14.66)	10 (6.62)	0.04
OVERLAP HAI AND CBP (%)	5 (6.66)	1 (0.66)	0.04
OVERLAP CBP AND CEP (%)	0 (0)	1 (0.66)	0.04

CBP: Chronic Biliary Pancreatitis, CEP: Chronic Extrahepatic Pancreatitis, HAI: Hepatic Acute Inflammation, MELD-Na: Model for End-Stage Liver Disease with Sodium.