Published online Sep 21, 2022. doi: 10.3748/wjg.v28.i35.5175
Peer-review started: January 24, 2022
First decision: April 10, 2022
Revised: April 28, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: September 21, 2022
Hepatic hydrothorax (HH) is an uncommon and difficult-to-manage complication of cirrhosis with limited treatment options.
To define the clinical outcomes of patients presenting with HH managed with current standards-of-care and to identify factors associated with mortality.
Cirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 were retrospectively identified. HH was defined as pleural effusion in the absence of cardiopulmonary disease. The primary outcomes were overall and transplant-free survival at 12-mo after the index admission. Cox proportional hazards analysis was used to determine factors associated with the primary outcomes.
Overall, 84 patients were included (mean age, 58 years) with a mean model for end-stage liver disease score of 29. Management with diuretics alone achieved long-term resolution of HH in only 12% patients. At least one thoracocentesis was performed in 73.8% patients, transjugular intrahepatic portosystemic shunt insertion in 11.9% patients and 33% patients received liver transplantation within 12-mo of index admission. Overall patient survival and transplant-free survival at 12 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 kidney injury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increased risk of mortality.
Cirrhotic patients with HH are a challenging population with a poor 12-mo survival despite current treatments. Current smoking and episodes of AKI are potential modifiable factors affecting survival. HH is often refractory of diuretic therapy and transplant assessment should be considered in all cases.
Core Tip: The development of hepatic hydrothorax (HH) in cirrhotic patients continues to be associated with a very poor prognosis despite current standards-of-care. In one of the largest series to investigate the natural history of patients with hepatic hydrothoraces, a 45-d overall survival rate of 80% and 12-mo transplant-free survival of 41% was observed after index hospitalisation with HH. At multivariate analysis, current smoking and development of acute kidney injury were both independently associated with mortality, and represent important modifiable risk factors.