Treatment outcomes in hepatic hydrothorax: A propensity score-matched survival analysis

This study evaluated the prognostic impact of hepatic hydrothorax (HH) in decompensated cirrhosis and compared outcomes between conservative therapy and surgical diaphragmatic repair.

This single-center retrospective cohort included 48,464 adults with decompensated cirrhosis from 2004 to 2024. After exclusions, 386 patients (0.8%) were identified with HH, of whom 120 underwent surgical repair and 266 received conservative management. Clinical characteristics and laboratory data were analyzed. The primary endpoint was 365-day mortality. Propensity score matching (1:1, caliper 0.2) incorporating eight clinically relevant variables was used to balance baseline differences. Mortality risk was assessed using generalized estimating equations and Cox proportional hazards models.

Before matching, the conservative group had more severe liver dysfunction, with higher Child-Pugh scores (10.3 ± 3.0 vs. 8.8 ± 2.7, p < 0.001), while MELD scores were lower (16.5 ± 2.4 vs. 26.28 ± 16.17, p < 0.001). The 365-day mortality was 64.3% (171/266) in the conservative therapy group and 51.7% (62/120) in the surgical repair group, corresponding to a crude risk ratio of 1.24 (95% CI, 1.01-1.53) and an odds ratio of 1.69 (95% CI, 1.08-2.65). Survival analysis demonstrated a significant difference between groups (unadjusted log-rank test, χ² = 8.330, p = 0.004). After matching, 119 pairs showed well-balanced baseline characteristics. In the matched cohort, 1-year mortality remained lower with surgery (40.3% vs. 59.7%; Cohen's h = 0.39).

Surgical diaphragmatic repair was associated with lower 1-year mortality compared with conservative management after adjustment for measured baseline differences.