Department of Medicine, Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX, 75216, USA.
Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Dig Dis Sci. 2021 Oct;66(10):3612-3618. doi: 10.1007/s10620-020-06677-6. Epub 2020 Nov 13.
Hepatic hydrothorax (HH) remains a difficult-to-treat complication of cirrhosis.
To define the mortality, length of stay (LOS), and risk of ACLF in patients admitted with HH.
We utilized the North American Consortium for the Study of End-stage Liver Disease, a prospective cohort of 2868 non-electively hospitalized patients with cirrhosis from 14 tertiary care hepatology centers in North America. A total of 121 patients who required an inpatient thoracentesis (HH group) were compared to 736 patients with refractory ascites without HH, and to 1639 patients without these complications (Other). Patients with a TIPS before or during admission were excluded.
There were no differences between the groups in age, gender, or liver disease etiology. Admission MELD (20.5, 21.6 vs. 18.7; p < 0.0001) was lower in HH than RA patients but lowest in other patients, respectively. In hospital, HH patients' rate of second infections and ICU transfer were the highest, and their LOS was the longest of all groups. Despite a similar mean discharge MELD compared to RA patients, the 90-day transplant rate was lower. Multivariable modeling showed patients with HH had an increased risk of ACLF (HR = 2.37 vs. RA, HR = 2.56 vs. Other; p = 0.01) even when controlling for MELD score, AKI, second infection, and history of prior 6-month hospitalization. Multivariable modeling also showed that HH increased the risk of inpatient mortality (HR = 2.22 vs. RA alone, HR = 2.31 vs. Other; p = 0.04).
HH that required a therapeutic thoracentesis more than doubled the risk of ACLF and inpatient mortality among hospitalized patients with cirrhosis.
肝性胸水（HH）仍然是肝硬化的一种难以治疗的并发症。
确定因 HH 住院的患者的死亡率、住院时间（LOS）和 ACLF 风险。
我们利用北美终末期肝病研究联合会（North American Consortium for the Study of End-stage Liver Disease），这是一个由北美 14 个三级保健肝病中心的 2868 名非择期住院肝硬化患者组成的前瞻性队列。与 736 名无 HH 的难治性腹水患者和 1639 名无这些并发症的患者（其他）相比，我们比较了 121 名需要住院胸腔穿刺术（HH 组）的患者。在入院前或入院期间接受 TIPS 的患者被排除在外。
三组患者在年龄、性别或肝病病因方面无差异。HH 组患者入院时 MELD 评分（20.5、21.6 与 18.7；p<0.0001）低于 RA 患者，但低于其他患者。在住院期间，HH 患者的二次感染和 ICU 转率最高，住院时间最长。尽管与 RA 患者相比，出院时 MELD 评分相似，但 90 天的移植率较低。多变量建模显示，HH 患者发生 ACLF 的风险增加（HR=2.37 比 RA，HR=2.56 比其他；p=0.01），即使控制了 MELD 评分、AKI、二次感染和 6 个月内既往住院史。多变量建模还显示，HH 增加了住院期间死亡率的风险（HR=2.22 比 RA 单独，HR=2.31 比其他；p=0.04）。
需要治疗性胸腔穿刺术的 HH 使肝硬化住院患者发生 ACLF 和住院期间死亡率的风险增加了一倍以上。
