Retrospective Cohort Study
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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2022; 28(35): 5175-5187
Published online Sep 21, 2022. doi: 10.3748/wjg.v28.i35.5175
Table 1 Baseline characteristics of patients with cirrhosis during the index hospital admission for hepatic hydrothorax (n = 84)
Characteristic Statistic Age, mean ± SD, yr 58.3 ± 11.5 Male, n (%) 46 (54.8) Diabetes mellitus, n (%) 23 (27.4) Ischaemic heart disease, n (%) 7 (8.3) Heart failure, n (%) 4 (4.8) Chronic obstructive lung disease, n (%) 5 (6.0) Hepatocellular carcinoma, n (%) 23 (27.4) Other cancer, n (%) 3 (3.6) Chronic kidney disease, n (%) 11 (13.1) Current smoker, n (%) 12 (14.3) Current alcohol drinker, n (%) 9 (10.7) Aetiology of liver disease1 , n (%) Hepatitis C virus 25 (29.8) Non-alcoholic fatty liver 17 (20.2) Alcoholic liver disease 13 (15.5) Hepatitis B virus 9 (10.7) Primary biliary cirrhosis/sclerosing cholangitis 7 (8.3) Cryptogenic 7 (8.3) Autoimmune hepatitis 6 (7.1) Budd-Chiari syndrome 3 (3.6) Metabolic/others2 7 (8.3) MELD score, mean ± SD 26.8 ± 7.1 Platelet count, median (IQR), per nL 103 (65-132) Platelet count < 50/nL, n (%) 9 (10.7) Anticoagulation, n (%) 6 (7.1) Previous ascitic taps, n (%) 69 (82.1) Beta-blockers, n (%) 11 (13.1) Lactulose, n (%) 34 (40.5) Rifaximin, n (%) 14 (16.7) SBP prophylaxis, n (%) 32 (38.1)
Table 2 Clinical features of hepatic hydrothorax, management, and complications
Characteristic Index admission (n = 84) Readmissions (n = 83) NYHA severity of dyspnoea, n (%) Class I 13 (15.5) 4 (4.3) Class II 23 (27.4) 37 (39.4) Class III 28 (33.3) 22 (23.4) Class IV 20 (23.8) 31 (33.0) Distribution of hydrothorax, n (%) Unilateral, left 13 (15.5) 10 (12.1) Unilateral, right 68 (81.0) 72 (86.8) Bilateral 3 (3.6) 1 (1.2) Admission hepatic encephalopathy, n (%) 12 (14.3) 14 (16.9) De novo hepatic encephalopathy, n (%)11 (13.1) 10 (12.0) Thoracocentesis performed, n (%) 53 (63.1) 62 (74.7) Pneumothorax, n (% of procedures) 6 (11.3) 11 (17.7) Haematoma, n (% of procedures) 2 (3.8) 1 (1.6) Pre-procedure platelet infusion, n (%) 11 (13.3) 6 (7.2) Pre-procedure blood products1 , n (%) 18 (21.7) 12 (14.5) Pleural fluid drained, mean ± SD, litres 2.8 ± 1.7 3.0 ± 1.5 Indwelling intercostal catheter, n (%) 10 (11.9) 8 (9.6) Infection, n (%) 17 (20.2) 14 (16.9) Acute kidney injury, n (%) 30 (35.7) 28 (33.7) Concurrent ascites drainage, n (%) 23 (27.1) 24 (28.9) Volume drained, mean ± SD, litres 6.0 ± 3.1 5.5 ± 2.1 TIPS performed, n (%) 2 (2.4) 8 (9.6) Furosemide, n (%) None 27 (32.1) 9 (10.8) 20 to < 100 mg daily 52 (61.9) 60 (72.3) 100 to 240 mg daily 5 (5.6) 14 (16.9) Spironolactone, n (%) None 27 (32.1) 18 (21.7) 25 to < 100 mg daily 15 (17.9) 22 (26.5) 100 to 300 mg daily 42 (50.0) 43 (51.8)
Table 3 Univariable Cox regression on patient survival to 12 mo
Enduring variables Overall1 , 12-mo survival Transplant-free, 12-mo survival HR (95%CI) HR (95%CI) Age, per 5-yr 1.13 (0.94-1.35) 0.95 (0.85-1.07) Male sex 2.05 (0.84-4.99) 1.68 (0.94-3.00) Diabetes 0.56 (0.25-1.50) 0.39 (0.19-0.81) Ischaemic heart disease 2.00 (0.68-5.92) 0.80 (0.29-2.23) Heart failure 0.86 (0.12-6.38) 0.35 (0.05-2.55) Chronic obstructive lung disease NE 1.02 (0.32-3.30) Chronic kidney disease 1.13 (0.38-3.32) 0.82 (0.37-1.83) Hepatocellular carcinoma 2.11 (0.92-4.81) 1.55 (0.87-2.76) Hepatitis B 3.36 (1.32-8.53) 1.68 (0.75-3.74) Hepatitis C 0.81 (0.32-2.05) 1.28 (0.71-2.28) Alcoholic liver disease 0.76 (0.22-2.55) 0.94 (0.44-2.01) Non-alcoholic fatty liver 0.51 (0.15-1.73) 0.43 (0.18-1.02) Current smoking 5.01 (2.15-11.7) 2.27 (1.13-4.56) Current alcohol intake 0.68 (0.42-1.13) 0.93 (0.68-1.26) Time varying variables MELD score, per 5-points 1.28 (0.93-1.77) 1.82 (1.41-2.34) NYHA functional class 1.14 (0.74-1.75) 1.09 (0.81-1.46) TIPS procedure 0.37 (0.05-2.83) 0.13 (0.02-0.96) Acute kidney injury 2.57 (1.13-5.88) 2.36 (1.35-4.11) Thoracocentesis 0.51 (0.23-1.16) 1.28 (0.70-2.34) Pneumothorax 2.37 (0.80-7.00) 2.78 (1.39-5.56) Intercostal catheter inserted 1.56 (0.53-4.62) 1.85 (0.90-3.82) Admission hepatic encephalopathy None 1.00 (reference) 1.00 (reference) Mild 0.75 (0.17-3.25) 1.21 (0.54-2.70) Severe 11.4 (3.28-39.6) 7.93 (2.36-26.6) Encephalopathy during admission2 2.30 (0.84-6.32) 3.20 (1.65-6.24) Any encephalopathy 2.30 (0.97-5.45) 2.21 (1.22-4.03)
Table 4 Multivariable Cox regression on patient survival to 12 mo
Model and variables AHR (95%CI) P value Bootstrap CI P value Overall survival 1 Age, per 5-yr increase 1.30 (1.01-1.67) 0.043 0.91-1.85 0.15 MELD score, per 5 points 1.53 (1.06-1.67) 0.025 0.89-2.66 0.13 Current smoking 8.65 (3.43-21.9) < 0.001 2.54-29.5 0.001 Acute kidney injury 2.91 (1.21-6.97) 0.017 1.04-8.12 0.042 Transplant-free survival Hepatic encephalopathy 2.00 (1.08-3.67) 0.030 0.93-4.28 0.078 MELD score, per 5 points 1.78 (1.38-2.29) < 0.001 1.31-2.44 < 0.001 Current smoking 3.11 (1.49-6.52) 0.003 1.16-8.30 0.024 Acute kidney injury 2.18 (1.20-3.96) 0.011 1.10-4.31 0.026