Department of Internal Medicine, Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Department of Statistics, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Respiration. 2018;96(4):330-337. doi: 10.1159/000490001. Epub 2018 Jul 10.
Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear.
This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH.
Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure.
82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5-14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03-1.36, p = 0.012).
Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.
对于难治性肝性胸水（HH）患者，提供重复胸腔穿刺术以控制症状，但这种治疗策略的风险状况尚不清楚。
本研究旨在比较 HH 患者和非 HH 患者重复胸腔穿刺术时的并发症频率和性质。
2010 年至 2015 年，在一家单中心比较 HH 患者（n=82，274 次胸腔穿刺术）和对照组（非 HH 患者，n=100，188 次胸腔穿刺术）接受重复胸腔穿刺术以缓解症状时的并发症发生率。记录患者的人口统计学、实验室值、胸腔穿刺术次数以及每次操作的相关并发症。
整个队列中，在 462 次操作中有 17 次（0.03%）出现并发症。HH 组重复胸腔穿刺术的总体并发症发生率更高（8 例 vs. 0%，p=0.016，95%CI=1.5-14.6）。在 HH 组中，随着序贯胸腔穿刺术的进行，并发症的累积风险增加；前一次干预中的并发症是随后发生并发症的最强预测因素（OR=17.1，p=0.0013），且超过 1 次先前的并发症与随后发生并发症的风险增加 15 倍相关（p<0.001）。在 HH 组内的多变量分析中，终末期肝病模型（MELD）评分是血胸的独立预测因素（OR=1.19，95%CI=1.03-1.36，p=0.012）。
重复胸腔穿刺术总体上是一种低风险的操作，但 HH 患者的并发症发生率高于非 HH 患者。先前存在并发症会显著增加 HH 人群未来发生并发症的风险。
