Clinical Features of Refractory Ascites in Outpatients

Area of Science:

• Gastroenterology and Hepatology
• Internal Medicine
• Clinical Research

Background:

• Refractory ascites, a common complication of cirrhosis, significantly impacts patient quality of life and prognosis.
• Understanding the clinical characteristics and outcomes of refractory ascites is crucial for effective management.

Purpose of the Study:

• To delineate the clinical features and outcomes of outpatients diagnosed with refractory ascites.
• To compare the characteristics and complications between patients with refractory ascites and those with non-refractory ascites.

Main Methods:

• Prospective observational study enrolling patients with cirrhotic ascites.
• Inclusion criteria: clinical evaluation, sodium restriction, biochemical and urine tests, ascitic fluid analysis.
• Treatment included multidisciplinary evaluation, diuretic therapy, therapeutic serial paracentesis, and transjugular intrahepatic portosystemic shunt (TIPS) consideration.

Main Results:

• Alcoholism was the most common cause of cirrhosis in both refractory (49 patients) and non-refractory (11 patients) groups.
• Refractory ascites patients frequently presented with Child-Pugh class B cirrhosis, protein-energy malnutrition (81.6%), hernias (44.9%), and hepatic encephalopathy (51%).
• Higher prevalence of spontaneous bacterial peritonitis and upper digestive hemorrhage was observed in the refractory group compared to the non-refractory group.

Conclusions:

• Patients with refractory ascites exhibit significant malnutrition, a high incidence of hernias, and a greater burden of complications.
• The study highlights a high frequency of postoperative mortality in refractory ascites patients, predominantly due to infectious causes.
• These findings underscore the need for comprehensive management strategies addressing nutritional status, hernias, and infection prevention in refractory ascites.