Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2020; 12(12): 1267-1275
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1267
Timing of paracentesis and outcomes in hospitalized patients with decompensated cirrhosis
Cristina Tocia, Andrei Dumitru, Luana Alexandrescu, Razvan Popescu, Eugen Dumitru
Cristina Tocia, Andrei Dumitru, Luana Alexandrescu, Eugen Dumitru, Department of Gastroenterology, Constanta County Clinical Emergency Hospital, Constanta 900647, Romania
Razvan Popescu, Department of General Surgery, Constanta County Clinical Emergency Hospital, Constanta 900647, Romania
Author contributions: Tocia C and Dumitru A contributed equally to this work; Tocia C and Dumitru A designed the study, performed the research, collected and analyzed the data, and wrote the manuscript; Dumitru E conceived and supervised the study and performed the critical review; Alexandrescu L and Popescu R performed the literature research and interpreted the data. All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional reviewer.
Conflict-of-interest statement: Nothing to disclose.
Data sharing statement: Data set and statistics available from the corresponding author at dr.andreidumitru@gmail.com.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrei Dumitru, MD, Academic Fellow, Department of Gastroenterology, Constanta County Clinical Emergency Hospital, Bd Tomis no 145, Constanta 900647, Romania. dr.andreidumitru@gmail.com
Received: July 17, 2020
Peer-review started: July 17, 2020
First decision: September 21, 2020
Revised: October 3, 2020
Accepted: October 27, 2020
Article in press: October 27, 2020
Published online: December 27, 2020
Processing time: 153 Days and 10.4 Hours
Abstract
BACKGROUND

Ascites is one of the most common complications of cirrhosis, placing a significant burden on the healthcare system. Data regarding the optimal time of paracentesis and outcomes among patients with cirrhosis and ascites are scarce.

AIM

To assess the outcomes of patients who underwent paracentesis within 12 h after admission compared to patients who underwent paracentesis later than 12 h.

METHODS

The study included 185 patients with cirrhosis and ascites who underwent paracentesis. The early paracentesis group was defined as paracentesis performed < 12 h after admission (65 patients) and the delayed paracentesis group was defined as paracentesis performed > 12 h after admission (120 patients). New-onset complications of cirrhosis, length of hospital stay, weekday or weekend admission, in-hospital mortality rate, and 90-d readmission rates were assessed and compared between the groups.

RESULTS

Significantly more patients in the delayed paracentesis group than in the early paracentesis group developed hepatic encephalopathy (45% vs 21.5%, P < 0.01), hepato-renal syndrome (21.6% vs 9.2%, P = 0.03) and infections (25% vs 10.7%, P = 0.02) during hospitalization. There were no statistically significant differences in the occurrence of spontaneous bacterial peritonitis and upper gastrointestinal bleeding between the two groups. Length of stay was shorter in the early paracentesis group than in the delayed paracentesis group (6.7 d vs 12.2 d) and in-hospital mortality was lower among patients in the early paracentesis group. Patients in the delayed paracentesis group had a higher risk of developing complications during hospitalization.

CONCLUSION

Early paracentesis (within 12 h after admission) could be a new inpatient quality metric among patients hospitalized with cirrhosis and ascites as it is associated with fewer complications of cirrhosis, lower in-hospital mortality and shorter length of stay.

Keywords: Cirrhosis; Ascites; Hepatic encephalopathy; Spontaneous bacterial peritonitis; Early paracentesis; Delayed paracentesis

Core Tip: Data regarding the optimal time of paracentesis and outcomes among patients with cirrhosis and ascites are scarce. We evaluated the outcomes of 185 patients with cirrhosis and ascites who underwent paracentesis within 12 h after admission (65 patients) compared to patients who underwent paracentesis later than 12 h (120 patients) and we found that early paracentesis is associated with fewer complications, lower in-hospital mortality and shorter length of stay.