Meliagros Pete, Chopski Benjamin, Ambrosio Matthew, Liu Stanley, Albhaisi Somaya, Petrova Lana, Ritter Evan, Garber Adam
Department of Internal Medicine, Hospital Medicine, Virginia Commonwealth University Health System/VCU Health, Richmond, Virginia, USA.
Division of Hospital Medicine, Department of Internal Medicine, Virginia Commonwealth University Health System/VCU Health, Richmond, Virginia, USA.
J Hosp Med. 2025 Sep;20(9):943-952. doi: 10.1002/jhm.70037. Epub 2025 Mar 27.
Paracentesis is a commonly performed procedure with overall low complication rates. There is a paucity of modern data investigating outcomes for inpatients using standardized point of care ultrasound.
We aimed to evaluate complication rates and outcomes of paracentesis in patients in the inpatient setting of a large tertiary transplantation center.
We identified patients with ascites of multiple etiologies undergoing paracentesis by a medicine procedure service at a university center. Univariate and multivariate analyses were conducted to identify clinical and demographic factors associated with kidney injury (AKI) or significant HGB drop (≥2 g/dL).
Of 1746 patients, 12% of patients receiving small volume (≤5 L) and 10% receiving large volume paracentesis (>5 L) developed a post procedural AKI (OR 0.857, 95% CI: 0.633-1.154) with no significant difference between groups (p = .30). In multivariable analysis, Model for End-Stage Liver Disease Sodium (MELD-Na) score as a continuous variable had a more significant impact in the development of AKI (OR 1.15 CI 1.08-1.22, p < .001) as well as patients who were noted to be receiving paracentesis due to clinical deterioration (OR 2.48 CI 1.08-5.7, p < .03). Of 2034 patients, 94% of patients had no significant drop in hemoglobin (<2 g/dL). There was no significant difference in BMI (12.73 vs. 16.68, p = .6), INR (1.6 vs. 1.6, p = .8), or platelet count (114 vs. 106, p > .9) between groups.
Regardless of volume of ascites removed, paracentesis is associated with a low risk of AKI, however there was an increased risk in the clinically decompensating patient. The bleeding risk was also found to be low when performed by experienced proceduralists on a procedure service.
腹腔穿刺术是一种常用的操作，总体并发症发生率较低。目前缺乏使用标准化床旁超声对住院患者治疗结果进行调查的现代数据。
我们旨在评估一家大型三级移植中心住院患者腹腔穿刺术的并发症发生率和治疗结果。
我们确定了在一所大学中心由内科操作服务进行腹腔穿刺术的多种病因腹水患者。进行单因素和多因素分析，以确定与肾损伤（AKI）或血红蛋白显著下降（≥2g/dL）相关的临床和人口统计学因素。
在1746例患者中，接受少量（≤5L）腹腔穿刺术的患者中有12%，接受大量（>5L）腹腔穿刺术的患者中有10%发生术后AKI（OR 0.857，95%CI：0.633-1.154），两组之间无显著差异（p = 0.30）。在多变量分析中，终末期肝病钠评分（MELD-Na）作为连续变量对AKI的发生影响更大（OR 1.15 CI 1.08-1.22，p < 0.001），以及因临床病情恶化而接受腹腔穿刺术的患者（OR 2.48 CI 1.08-5.7，p < 0.03）。在2034例患者中，94%的患者血红蛋白无显著下降（<2g/dL）。两组之间的BMI（12.73对16.68，p = 0.6）、INR（1.6对1.6，p = 0.8）或血小板计数（114对106，p > 0.9）无显著差异。
无论抽出腹水的量多少，腹腔穿刺术与AKI风险较低相关，但临床失代偿患者的风险增加。由经验丰富的操作医生在操作服务中进行时，出血风险也较低。
