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 important complication of cirrhosis, however management is often challenging and the natural history is poorly understood.
HH is a significant complication of cirrhosis, with a paucity of literature studying natural history and factors affecting survival.
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.
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.
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%.
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.
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.