Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and the Parkland Health and Hospital System, Dallas, TX, United States.
J Hepatol. 2013 Jun;58(6):1113-8. doi: 10.1016/j.jhep.2013.01.015. Epub 2013 Jan 21.
BACKGROUND & AIMS: Hemorrhagic ascites can pose diagnostic and therapeutic dilemmas in patients with cirrhosis. We aimed at exploring the characteristics and outcomes of patients with cirrhosis and hemorrhagic ascites.
The records of all patients with cirrhosis and ascites, who underwent paracentesis between 2003 and 2010 at Parkland Memorial Hospital, were retrospectively reviewed. Hemorrhagic ascites was defined as an ascitic fluid red blood cell (RBC) count ≥ 10,000/μl. We compared each patient with 3 age- and gender-matched controls (cirrhotic patients with ascites and an ascitic RBC count <10,000/μl). Survival curves were generated using Kaplan-Meier plots and compared using the log rank test.
1113 cirrhotic patients underwent paracentesis; 214 (19%) had hemorrhagic ascites. Patients with hemorrhagic ascites had higher rates of spontaneous bacterial peritonitis (p <0.001), acute kidney injury (AKI, p <0.001), and were more likely to require intensive care unit (ICU)-level care (p=0.01) compared to patients without hemorrhagic ascites. Patients with hemorrhagic ascites had a higher mortality than controls at one month (87% vs. 72%), 1 year (72% vs. 50%) and 3 years (61% vs. 41%). Using multivariate regression analysis, hemorrhagic ascites was also an independent predictor of mortality (HR 1.34, 95% CI 1.07-1.68) after adjusting for the model for end-stage liver disease score (HR 1.04, 1.03-1.05), ICU-level care (HR 2.02, 1.63-2.51) and presence of hepatocellular carcinoma (HR 2.27, 1.61-3.19).
Patients with hemorrhagic ascites had a significantly higher rate of ICU care, AKI, and mortality than patients with portal hypertension and ascites but without hemorrhagic ascites. We conclude that hemorrhagic ascites is a marker of advanced liver disease and poor outcome.
在肝硬化患者中，血性腹水可导致诊断和治疗困境。本研究旨在探讨肝硬化合并血性腹水患者的特征和结局。
回顾性分析 2003 年至 2010 年期间在 Parkland Memorial 医院接受腹穿的所有肝硬化伴腹水患者的病历资料。血性腹水定义为腹水红细胞（RBC）计数≥10,000/μl。我们将每位患者与 3 名年龄和性别匹配的对照者（肝硬化伴腹水且腹水 RBC 计数＜10,000/μl）进行比较。使用 Kaplan-Meier 曲线生成生存曲线，并使用对数秩检验进行比较。
1113 例肝硬化患者接受了腹穿；214 例（19%）发生血性腹水。与无血性腹水患者相比，血性腹水患者自发性细菌性腹膜炎（p＜0.001）、急性肾损伤（AKI，p＜0.001）发生率更高，更有可能需要重症监护病房（ICU）级别的治疗（p=0.01）。与对照组相比，血性腹水患者在 1 个月（87% vs. 72%）、1 年（72% vs. 50%）和 3 年（61% vs. 41%）时的死亡率更高。采用多变量回归分析，在校正终末期肝病模型评分（HR 1.04，1.03-1.05）、ICU 级别的治疗（HR 2.02，1.63-2.51）和存在肝细胞癌（HR 2.27，1.61-3.19）后，血性腹水也是死亡率的独立预测因素（HR 1.34，1.07-1.68）。
与门静脉高压伴腹水但无血性腹水的患者相比，血性腹水患者 ICU 治疗、AKI 和死亡率更高。我们的结论是，血性腹水是晚期肝病和不良预后的标志物。
