Cargando…

Clinical Features of Refractory Ascites in Outpatients

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Caly, Wanda Regina, Abreu, Rodrigo Martins, Bitelman, Bernardo, Carrilho, Flair José, Ono, Suzane Kioko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525166/
https://www.ncbi.nlm.nih.gov/pubmed/28792999
http://dx.doi.org/10.6061/clinics/2017(07)03
_version_ 1783252589362544640
author Caly, Wanda Regina
Abreu, Rodrigo Martins
Bitelman, Bernardo
Carrilho, Flair José
Ono, Suzane Kioko
author_facet Caly, Wanda Regina
Abreu, Rodrigo Martins
Bitelman, Bernardo
Carrilho, Flair José
Ono, Suzane Kioko
author_sort Caly, Wanda Regina
collection PubMed
description 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.
format Online
Article
Text
id pubmed-5525166
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
record_format MEDLINE/PubMed
spelling pubmed-55251662017-07-26 Clinical Features of Refractory Ascites in Outpatients Caly, Wanda Regina Abreu, Rodrigo Martins Bitelman, Bernardo Carrilho, Flair José Ono, Suzane Kioko Clinics (Sao Paulo) Clinical Science 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. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 2017-07 2017-07 /pmc/articles/PMC5525166/ /pubmed/28792999 http://dx.doi.org/10.6061/clinics/2017(07)03 Text en Copyright © 2017 CLINICS http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
spellingShingle Clinical Science
Caly, Wanda Regina
Abreu, Rodrigo Martins
Bitelman, Bernardo
Carrilho, Flair José
Ono, Suzane Kioko
Clinical Features of Refractory Ascites in Outpatients
title Clinical Features of Refractory Ascites in Outpatients
title_full Clinical Features of Refractory Ascites in Outpatients
title_fullStr Clinical Features of Refractory Ascites in Outpatients
title_full_unstemmed Clinical Features of Refractory Ascites in Outpatients
title_short Clinical Features of Refractory Ascites in Outpatients
title_sort clinical features of refractory ascites in outpatients
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525166/
https://www.ncbi.nlm.nih.gov/pubmed/28792999
http://dx.doi.org/10.6061/clinics/2017(07)03
work_keys_str_mv AT calywandaregina clinicalfeaturesofrefractoryascitesinoutpatients
AT abreurodrigomartins clinicalfeaturesofrefractoryascitesinoutpatients
AT bitelmanbernardo clinicalfeaturesofrefractoryascitesinoutpatients
AT carrilhoflairjose clinicalfeaturesofrefractoryascitesinoutpatients
AT onosuzanekioko clinicalfeaturesofrefractoryascitesinoutpatients