Prognostic Relevance of Ascites Volume and Dynamics in Outpatients with Cirrhosis: A Prospective Cohort Study

Background and Aims: Ascites is a common complication of cirrhosis. Its presence is associated with poorer outcomes. This study evaluates the association between ascites burden, including absolute thickness and longitudinal changes as a surrogate parameter of ascites volume and dynamics, and transplant-free survival in patients with cirrhosis. Methods: In this prospective single-center study, patients with cirrhosis underwent blood analysis, physical examination, and standardized ultrasound assessment of ascites at inclusion and after 3 months. Ascites burden was assessed by measuring ascites thickness in predefined abdominal compartments, which served as a surrogate for ascites volume. A 12-month follow-up recorded clinical progress, hospitalizations, decompensation, liver failure, transplantation, and death. Results: A total of 272 patients with cirrhosis (males 60%, median age 56 years, median MELD-Na 14) were included. Among them, 40 (15%) died or underwent liver transplantation during follow-up. These patients had significantly greater ascites thickness in all abdominal compartments at both time points as compared to survivors (all p < 0.001). In univariable analyses, greater baseline ascites thickness was associated with adverse outcome, with the strongest association observed for perisplenic ascites (OR 1.13, 95% CI 1.06-1.21; p < 0.001). In multivariate analysis, only baseline perihepatic ascites remained significantly associated with the endpoint (OR = 1.05, 95% CI [1.00-1.11], p = 0.045). The decrease in perisplenic ascites thickness during follow-up was in turn significantly associated with reduced risk of death or transplantation (OR 0.85, 95% CI [0.72-0.96], p = 0.017). Conclusions: In this prospective cohort, greater ascites thickness was associated with adverse outcomes in cirrhosis. Baseline perihepatic ascites and dynamic changes in perisplenic ascites emerged as potentially informative markers; however, these findings should be interpreted cautiously and require validation in larger cohorts.