Complications of thoracentesis in cirrhotic patients with pleural effusion.
OBJECTIVE
To study the complications of thoracentesis, either diagnostic or therapeutic, in cirrhotic patients with pleural effusion.


METHODS
A cohort prospective study. A diagnostic thoracentesis was performed at admission or when spontaneous bacterial empyema was suspected; a therapeutic thoracentesis was conducted in patients with dyspnea that did not improve with medical treatment. A chest radiography and a careful clinical follow up were performed in all patients within 24 hours after the procedure. We studied the risk factors for developing pneumothorax and the actuarial probability of pneumothorax after consecutive therapeutic thoracentesis.


METHODS
All cirrhotic patients admitted with pleural effusion over a 4-year period. The study included 69 patients.


RESULTS
During the study period, we performed 245 thoracentesis, 150 diagnostic and 95 therapeutic ones. The most severe complication was pneumothorax in 10 cases (4%), after 2 out of 150 (1.3%) diagnostic thoracentesis and after 8 out of 95 (8.4%) therapeutic thoracentesis (RR, 95% CI 6.8, 1.41-32.77, p < 0.01). The actuarial risk of pneumothorax after the first, second and fourth therapeutic thoracentesis was 7.7%, 25.3% and 34.7%, respectively.


CONCLUSIONS
Diagnostic thoracentesis in cirrhotic patients is associated to a low morbidity. Therapeutic thoracentesis is a risk factor for pneumothorax and the risk increases after consecutive thoracentesis. A chest radiograph is not justified after a diagnostic thoracentesis, but should be done after a therapeutic thoracentesis.
Castellote
J
J
Digestive Service, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. jcastellote@csub.scs.es
Xiol
X
X
Cortés-Beut
R
R
Tremosa
G
G
Rodríguez
E
E
Vázquez
S
S
D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000209:etiology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D010996:Pleural Effusion / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors