Clinical Features of Refractory Ascites in Outpatients

Authors

  • Wanda Regina Caly Universidade de São Paulo; Faculdade de Medicina FMUSP; Departamento de Gastroenterologia
  • Rodrigo Martins Abreu Universidade de São Paulo; Faculdade de Medicina FMUSP; Departamento de Gastroenterologia
  • Bernardo Bitelman Universidade de São Paulo; Faculdade de Medicina FMUSP; Departamento de Gastroenterologia
  • Flair José Carrilho Universidade de São Paulo; Faculdade de Medicina FMUSP; Departamento de Gastroenterologia
  • Suzane Kioko Ono Universidade de São Paulo; Faculdade de Medicina FMUSP; Departamento de Gastroenterologia

DOI:

https://doi.org/10.6061/clinics/2017(07)03

Keywords:

Ascites, Hepatic Encephalopathy, Liver, Liver Cirrhosis, Outpatients

Abstract

OBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month. RESULTS: The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R) and 11 non-refractory ascites (NR)]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034). The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively). Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262). CONCLUSION: Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes.

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Published

2017-07-01

Issue

Section

Clinical Sciences

How to Cite

Caly, W. R., Abreu, R. M., Bitelman, B., Carrilho, F. J., & Ono, S. K. (2017). Clinical Features of Refractory Ascites in Outpatients. Clinics, 72(7), 405-410. https://doi.org/10.6061/clinics/2017(07)03