CLINICS

Clinics (Sao Paulo). 2017 July; 72(7): 405-410.
doi:10.6061/clinics/2017(07)03

Copyright © 2017 CLINICS

Clinical Features of Refractory Ascites in Outpatients

Wanda Regina Caly , Rodrigo Martins Abreu , Bernardo Bitelman , Flair José Carrilho , Suzane Kioko Ono *

Departamento de Gastroenterologia, Divisao de Gastroenterologia e Hepatologia Clinica, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR

*Corresponding author. E-mail: skon@usp.br

received October 18, 2016; revised January 12, 2017; accepted February 16, 2017.

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.

Keywords: Ascites, Hepatic Encephalopathy, Liver, Liver Cirrhosis, Outpatients


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