Retrospective Cohort Study
Copyright ©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
Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax
Marcus Robertson, Samuel Hui, Lynna Chen, Rachel Shingaki-Wells, Chamani Kodikara, Gurpreet Singh, Andy KH Lim, Sarah Romero
Sarah Romero, Chamani Kodikara, Rachel Shingaki-Wells, Samuel Hui, Marcus Robertson, Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
Andy KH Lim, Marcus Robertson, Department of General Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
Gurpreet Singh, Lynna Chen, Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
Author contributions: Romero S, Lim AK and Robertson M performed literature review, data analysis and interpretation and manuscript composition and critical revision; Lim AK, Robertson M and Hui S conducted statistical analysis; Romero S, Singh G, Kodikara C, Shangaki-Wells R and Chen L performed data acquisition; Robertson M was responsible for study concept and design; and all authors have read and approved the final manuscript.
Institutional review board statement: 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).
Informed consent statement: The informed consent was waived by the Human Research Ethics Committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Patient consent was not obtained for this study, however study data has been anonymised.
STROBE statement: That authors have read the STROBE statement-checklist, and the manuscript was prepared and revised according to the STROBE statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sarah Romero, FRACP, MBBS, Doctor, Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton 3168, Victoria, Australia.
Received: January 24, 2022
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
Research background

Hepatic hydrothorax (HH) is an important complication of cirrhosis, however management is often challenging and the natural history is poorly understood.

Research motivation

HH is a significant complication of cirrhosis, with a paucity of literature studying natural history and factors affecting survival.

Research objectives

This study sought to: (1) Evaluate factors associated with survival in a cohort of patients hospitalised with HH; and (2) Provide descriptive analysis of treatments, complications and outcomes following HH hospitalisation.

Research methods

Cirrhotic patients with HH presenting to three tertiary centres from 2010 to 2018 were retrospectively identified. Patients were followed-up from the date of first hospital admission with HH to an endpoint of death, liver transplantation (LT) or end of the study period. The primary outcomes were overall and transplant free survival at 12 mo after the index admission. The secondary outcomes included the incidence of specific treatments of HH and associated complications and to determine patient-specific prognostic factors associated with mortality.

Research results

Only 12% of patients achieved long-term resolution of HH with diuretic therapy alone. 74% of patients required thoracocentesis, with 15% of procedures being complicated by pneumothorax. 12-mo transplant free survival was 41%. 45-d overall survival was 80%.

Research conclusions

The development of HH is associated with poor transplant-free survival despite current standards-of-care and should prompt consideration of the appropriateness of LT in all patients. HH is often refractory to both conservative and invasive management and patients frequently require repeat hospitalisations. Active smoking and acute kidney injury may be important modifiable risk factors to reduce mortality in cirrhotic patients with HH.

Research perspectives

This study represents one of the largest series examining survival in persons hospitalised with HH, and importantly has identified modifiable risk factors that may alter the natural history in this challenging patient population.