Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax  

作　　者：Sarah Romero Andy KH Lim Gurpreet Singh Chamani Kodikara Rachel Shingaki-Wells Lynna Chen Samuel Hui Marcus Robertson 

机构地区：[1]Department of Gastroenterology,Monash Health,Clayton 3168,Victoria,Australia [2]Department of General Medicine,School of Clinical Sciences,Monash University,Clayton 3168,Victoria,Australia [3]Gastroenterology and Liver Transplant Unit,Austin Health,Heidelberg 3084,Victoria,Australia

出　　处：《World Journal of Gastroenterology》2022年第35期5175-5187,共13页世界胃肠病学杂志（英文版）

基　　金：The Human Research Ethics Committee at Monash Health and Austin Health approved the study as a quality assurance activity and the committee provided a waiver for informed consent(RES-19-0000-343Q).

摘　　要：BACKGROUNDHepatic hydrothorax (HH) is an uncommon and difficult-to-manage complicationof cirrhosis with limited treatment options.AIMTo define the clinical outcomes of patients presenting with HH managed withcurrent standards-of-care and to identify factors associated with mortality.METHODSCirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 wereretrospectively identified. HH was defined as pleural effusion in the absence ofcardiopulmonary disease. The primary outcomes were overall and transplant-freesurvival at 12-mo after the index admission. Cox proportional hazards analysiswas used to determine factors associated with the primary outcomes.RESULTSOverall, 84 patients were included (mean age, 58 years) with a mean model forend-stage liver disease score of 29. Management with diuretics alone achievedlong-term resolution of HH in only 12% patients. At least one thoracocentesis wasperformed in 73.8% patients, transjugular intrahepatic portosystemic shuntinsertion in 11.9% patients and 33% patients received liver transplantation within12-mo of index admission. Overall patient survival and transplant-free survival at12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidneyinjury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increasedrisk of mortality.CONCLUSIONCirrhotic patients with HH are a challenging population with a poor 12-mo survival despitecurrent treatments. Current smoking and episodes of AKI are potential modifiable factors affectingsurvival. HH is often refractory of diuretic therapy and transplant assessment should beconsidered in all cases.

关 键 词：CIRRHOSIS Portal hypertension Hepatic hydrothorax ASCITES Liver transplantation 

分 类 号：R575.2[医药卫生—消化系统]