Department of Internal Medicine, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA.
Department of Gastroenterology, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA.
Dig Dis Sci. 2022 Oct;67(10):4929-4938. doi: 10.1007/s10620-022-07522-8. Epub 2022 May 9.
Hepatic hydrothorax (HHT) is an uncommon but significant complication of cirrhosis and portal hypertension, associated with a worse prognosis and mortality. Nearly 25% of patients with HHT will have refractory pleural effusion. It is unclear if refractory HHT has a different prognosis compared to refractory ascites.
We aim to evaluate the prognostic significance of refractory HHT when compared to refractory ascites.
Forty-seven patients who had refractory HHT in a tertiary care center were identified, and matched, retrospectively, one-to-one by age, gender and MELD-Na with 47 patients with refractory ascites. One-year mortality rate was compared between both groups. Cox proportional hazard regression was used to identify the association between different covariates and primary endpoint.
The 1-year mortality was 51.06% in the HHT group compared to 19.15% in the refractory ascites group. The median survival for patients with refractory hepatic hydrothorax was 4.87 months while the median survival for patients with refractory ascites exceeded 1 year. The presence of HHT was statistically significant in predicting the development of 1-year mortality [Hazard Ratio (HR) 4.45, 95% Confidence Interval (CI) 2.25-8.82; P value < 0.001]. Furthermore, refractory HHT remained associated with one-year mortality after adjusting for all other covariates. In a subgroup of patients with MELD-Na ≤ 20, HHT continued to be a significant predictor of one-year mortality (HR 3.30, 95% CI 1.47-7.40; P value 0.004).
Refractory HHT is a significant independent predictor of mortality and offers additional prognostic value.
肝性胸水（HHT）是肝硬化和门静脉高压症的一种罕见但严重的并发症，与预后较差和死亡率较高相关。近 25%的 HHT 患者会出现难治性胸腔积液。目前尚不清楚难治性 HHT 是否比难治性腹水具有不同的预后。
我们旨在评估难治性 HHT 与难治性腹水相比的预后意义。
在一家三级保健中心确定了 47 例难治性 HHT 患者，并通过年龄、性别和 MELD-Na 进行回顾性一对一匹配，与 47 例难治性腹水患者进行匹配。比较两组患者的 1 年死亡率。使用 Cox 比例风险回归分析来确定不同协变量与主要终点之间的关联。
HHT 组的 1 年死亡率为 51.06%，难治性腹水组为 19.15%。难治性肝性胸水患者的中位生存期为 4.87 个月，而难治性腹水患者的中位生存期超过 1 年。HHT 的存在在预测 1 年死亡率方面具有统计学意义[风险比（HR）4.45，95%置信区间（CI）2.25-8.82；P 值<0.001]。此外，在调整了所有其他协变量后，难治性 HHT 仍然与 1 年死亡率相关。在 MELD-Na≤20 的患者亚组中，HHT 仍然是 1 年死亡率的显著预测因子（HR 3.30，95%CI 1.47-7.40；P 值 0.004）。
难治性 HHT 是死亡率的一个显著独立预测因子，并提供了额外的预后价值。
