Division of Gastroenterology and Hepatology, University of Michigan, 3912 Taubman, SPC 5362, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
Dig Dis Sci. 2022 Nov;67(11):5327-5335. doi: 10.1007/s10620-022-07454-3. Epub 2022 Mar 9.
The incidence of, risk factors for, and outcomes after the development of ascites are poorly described for contemporary patients with cirrhosis.
We examined data for a 20% random sample of US Medicare enrollees with cirrhosis and Part D prescription coverage from 2008 to 2019, excluding patients with heart failure and diuretic use prior to cirrhosis. Among 63,364 persons with cirrhosis, we evaluated the incidence of ascites using an Aalen-Johansen estimator. We evaluated risk factors for ascites, mortality, and mortality after ascites using multistate modeling. We determined the associations with each outcome for an array of medication exposures including nonselective beta-blockers, antiviral therapy, statins, rifaximin, anticoagulants, and metformin.
The cumulative incidence of ascites was 5.1%, 9.5%, and 10.7% and 1, 3, and 5 years overall. The corresponding data for ascites requiring paracentesis were 1%, 2.1%, and 2.4%. Persons aged < 65 years, with alcohol-related cirrhosis, varices, or HE, are most likely to develop ascites. The risk of ascites was higher for persons taking any NSBB (including carvedilol) but lower for those taking atorvastatin (but not other statins) and antiviral therapy for Hepatitis C. Incident ascites was associated with increased risk of death, HR 27.6 95%CI(21.7-35.1). Survival following ascites was 1.08 years (interquartile range, IQR, 0.26-2.75), 0.38 years (IQR0.1-1.3) for those requiring paracentesis. Lipophilic statins were the only medications associated with lower mortality after ascites requiring paracentesis.
Ascites is associated with a high risk of death. Very few candidate therapies are associated with the reduction in the risk of ascites and mortality after ascites development.
目前对于肝硬化患者，腹水的发生、风险因素和结局描述较差。
我们研究了 2008 年至 2019 年期间美国医疗保险和处方覆盖范围内 20%随机样本的肝硬化患者数据，排除心力衰竭和肝硬化前使用利尿剂的患者。在 63364 名肝硬化患者中，我们使用 Aalen-Johansen 估计器评估腹水的发生率。我们使用多状态模型评估腹水、死亡率和腹水后死亡率的风险因素。我们确定了一系列药物暴露与每种结局的关联，包括非选择性β受体阻滞剂、抗病毒治疗、他汀类药物、利福昔明、抗凝剂和二甲双胍。
腹水的累积发生率为 5.1%、9.5%和 10.7%，总发生率为 1、3 和 5 年。相应的腹水需要穿刺放液的数据分别为 1%、2.1%和 2.4%。年龄<65 岁、酒精性肝硬化、静脉曲张或肝性脑病的患者最有可能发生腹水。服用任何非选择性β受体阻滞剂（包括卡维地洛）的患者发生腹水的风险更高，但服用阿托伐他汀（而非其他他汀类药物）和丙型肝炎抗病毒治疗的患者发生腹水的风险较低。腹水的发生与死亡风险增加相关，HR 27.6（95%CI：21.7-35.1）。腹水后生存时间为 1.08 年（四分位距 IQR，0.26-2.75），需要穿刺放液的腹水患者生存时间为 0.38 年（IQR0.1-1.3）。亲脂性他汀类药物是唯一与腹水需要穿刺放液后死亡率降低相关的药物。
腹水与死亡风险增加相关。极少数候选疗法与减少腹水发生和腹水后死亡率相关。
