Natural history of patients hospitalized for management of cirrhotic ascites.
OBJECTIVE
Since the International Ascites Club published the diagnostic criteria of refractory ascites (RA) and hepatorenal syndrome (HRS), there have been few studies assessing the natural history of ascites. The aims of this study were to define the natural history of cirrhotic ascites and to identify prognostic factors for dilutional hyponatremia (DH), RA, HRS, and survival.


METHODS
Two hundred sixty-three consecutive cirrhotic patients were followed for 40.9 +/- 2.6 months after their first significant ascites.


RESULTS
During follow-up 74 (28.1%) patients developed DH, 30 (11.4%) RA (diuretic-resistant in 2 cases and diuretic-intractable because of the development of diuretic-induced complications in 28 cases), and 20 (7.6%) HRS (type 1, 7; type 2, 13). The 5-year probability of DH, RA, and HRS development was 37.1%, 11.4%, and 11.4%, respectively. The probability of survival at 1 and 5 years was 85% and 56.5%, respectively. The independent predictors for survival were baseline age, baseline Child-Pugh score, and DH development. The 1-year probability of survival after developing DH, RA, and type 2 HRS was 25.6%, 31.6%, and 38.5%, respectively. In contrast, the mean survival was only 7 +/- 2 days in those patients developing type 1 HRS.


CONCLUSIONS
(1) The survival of cirrhotic patients with first episode of ascites is relatively high, and it is mainly influenced by age and Child-Pugh score at the time of ascites decompensation, as well as by DH development. (2) The probability of RA and HRS development is relatively low, but they are associated with a poor prognosis.
Planas
Ramon
R
Liver Section, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Montoliu
Silvia
S
Ballesté
Belen
B
Rivera
Monica
M
Miquel
Mireia
M
Masnou
Helena
H
Galeras
Jose Antonio
JA
Giménez
María D
MD
Santos
Justiniano
J
Cirera
Isabel
I
Morillas
Rosa María
RM
Coll
Susanna
S
Solà
Ricard
R
D001201:Ascites / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006530:Hepatorenal Syndrome / Q000453:epidemiology; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016019:Survival Analysis