title: Natural history of patients hospitalized for management of cirrhotic ascites.
abstract: 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.
authors.affiliation: Liver Section, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Planas
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoliu
authors.forename: Belen
authors.initials: B
authors.lastname: Ballesté
authors.forename: Monica
authors.initials: M
authors.lastname: Rivera
authors.forename: Mireia
authors.initials: M
authors.lastname: Miquel
authors.forename: Helena
authors.initials: H
authors.lastname: Masnou
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Galeras
authors.forename: María D
authors.initials: MD
authors.lastname: Giménez
authors.forename: Justiniano
authors.initials: J
authors.lastname: Santos
authors.forename: Isabel
authors.initials: I
authors.lastname: Cirera
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Morillas
authors.forename: Susanna
authors.initials: S
authors.lastname: Coll
authors.forename: Ricard
authors.initials: R
authors.lastname: Solà
mesh_terms: 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