Romero S, Lim AK, Singh G, Kodikara C, Shingaki-Wells R, Chen L, Hui S, Robertson M. Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax. World J Gastroenterol 2022; 28(35): 5175-5187 [PMID: 36188717 DOI: 10.3748/wjg.v28.i35.5175]
Corresponding Author of This Article
Sarah Romero, FRACP, MBBS, Doctor, Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton 3168, Victoria, Australia. s.romero.md@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 21, 2022; 28(35): 5175-5187 Published online Sep 21, 2022. doi: 10.3748/wjg.v28.i35.5175
Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax
Sarah Romero, Andy KH Lim, Gurpreet Singh, Chamani Kodikara, Rachel Shingaki-Wells, Lynna Chen, Samuel Hui, Marcus Robertson
Sarah Romero, Chamani Kodikara, Rachel Shingaki-Wells, Samuel Hui, Marcus Robertson, Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
Andy KH Lim, Marcus Robertson, Department of General Medicine, School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
Gurpreet Singh, Lynna Chen, Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
Author contributions: Romero S, Lim AK and Robertson M performed literature review, data analysis and interpretation and manuscript composition and critical revision; Lim AK, Robertson M and Hui S conducted statistical analysis; Romero S, Singh G, Kodikara C, Shangaki-Wells R and Chen L performed data acquisition; Robertson M was responsible for study concept and design; and all authors have read and approved the final manuscript.
Institutional review board statement: The Human Research Ethics Committee at Monash Health and Austin Health approved the study as a quality assurance activity and the committee provided a waiver for informed consent (RES-19-0000-343Q).
Informed consent statement: The informed consent was waived by the Human Research Ethics Committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at s.romero.md@gmail.com. Patient consent was not obtained for this study, however study data has been anonymised.
STROBE statement: That authors have read the STROBE statement-checklist, and the manuscript was prepared and revised according to the STROBE statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sarah Romero, FRACP, MBBS, Doctor, Department of Gastroenterology, Monash Health, 246 Clayton Road, Clayton 3168, Victoria, Australia. s.romero.md@gmail.com
Received: January 24, 2022 Peer-review started: January 24, 2022 First decision: April 10, 2022 Revised: April 28, 2022 Accepted: July 25, 2022 Article in press: July 25, 2022 Published online: September 21, 2022 Processing time: 234 Days and 6.4 Hours
Abstract
BACKGROUND
Hepatic hydrothorax (HH) is an uncommon and difficult-to-manage complication of cirrhosis with limited treatment options.
AIM
To define the clinical outcomes of patients presenting with HH managed with current standards-of-care and to identify factors associated with mortality.
METHODS
Cirrhotic patients with HH presenting to 3 tertiary centres from 2010 to 2018 were retrospectively identified. HH was defined as pleural effusion in the absence of cardiopulmonary disease. The primary outcomes were overall and transplant-free survival at 12-mo after the index admission. Cox proportional hazards analysis was used to determine factors associated with the primary outcomes.
RESULTS
Overall, 84 patients were included (mean age, 58 years) with a mean model for end-stage liver disease score of 29. Management with diuretics alone achieved long-term resolution of HH in only 12% patients. At least one thoracocentesis was performed in 73.8% patients, transjugular intrahepatic portosystemic shunt insertion in 11.9% patients and 33% patients received liver transplantation within 12-mo of index admission. Overall patient survival and transplant-free survival at 12 mo were 68% and 41% respectively. At multivariable analysis, current smoking [hazard ratio (HR) = 8.65, 95% confidence interval (CI): 3.43-21.9, P < 0.001) and acute kidney injury (AKI) (HR = 2.91, 95%CI: 1.21-6.97, P = 0.017) were associated with a significantly increased risk of mortality.
CONCLUSION
Cirrhotic patients with HH are a challenging population with a poor 12-mo survival despite current treatments. Current smoking and episodes of AKI are potential modifiable factors affecting survival. HH is often refractory of diuretic therapy and transplant assessment should be considered in all cases.
Core Tip: The development of hepatic hydrothorax (HH) in cirrhotic patients continues to be associated with a very poor prognosis despite current standards-of-care. In one of the largest series to investigate the natural history of patients with hepatic hydrothoraces, a 45-d overall survival rate of 80% and 12-mo transplant-free survival of 41% was observed after index hospitalisation with HH. At multivariate analysis, current smoking and development of acute kidney injury were both independently associated with mortality, and represent important modifiable risk factors.
