title: Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites.
abstract: BACKGROUND
  The prevalence of spontaneous bacterial peritonitis (SBP) in hospitalised cirrhotics with ascites is 10-30%. Treatment for refractory ascites includes paracenteses, transjugular intrahepatic portosystemic shunt or drain placement; the latter is discouraged due to a perceived infection risk.
  
  
  OBJECTIVE
  This study aimed to evaluate the risk of bacterial peritonitis (BP) with peritoneal drains in patients with Child-Pugh class B or C cirrhosis and determine their impact on survival.
  
  
  METHODS
  We conducted a retrospective review of end-stage liver disease (ESLD) patients with non-malignant, refractory ascites who had peritoneal drains placed for ≥3 days at Loyola University between 1999 and 2009. Cell counts were performed at drain placement and within 72 h. BP was defined as ascitic polymorphonuclear neutrophils >250/mm(3) . Univariate analysis assessed the association between demographics, laboratory markers and development of BP. Kaplan-Meier curve estimates by infection were constructed and survival distributions were compared using log-rank statistic.
  
  
  RESULTS
  There were 227 drain placements during the study period. Twenty-two per cent were diagnosed with BP (12% had SBP at drain placement; 10% developed BP within 72 h). There was no association between BP and baseline characteristics. Patients who developed BP within 72 h of drain placement had 50% mortality at 5 months compared with 50 months in those without infection (log-rank P ≤ 0.003).
  
  
  CONCLUSIONS
  In ESLD patients who received an indwelling peritoneal catheter, there was 10% risk of developing BP and significant mortality increase. Though placing drains is not the mainstay of treatment for refractory ascites, we confirm the theoretical adverse risk of peritoneal drains on infection and survival in cirrhotics.
authors.affiliation: Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Kathpalia
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: A
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Department of Transplant Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Robertazzi
authors.affiliation: Department of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Cohen
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Edward Hines, Jr VA Hospital, Hines, Illinois, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sontag
authors.affiliation: Department of Public Health Sciences, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: A
authors.initials: A
authors.lastname: Luke
authors.affiliation: Department of Public Health Sciences, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: R
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.affiliation: Department of Gastroenterology and Hepatology, Emory University Hospital, Atlanta, Georgia, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Pillai
mesh_terms: D001201:Ascites / Q000601:surgery*; D001424:Bacterial Infections / Q000401:mortality*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects*; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000401:mortality*; D012189:Retrospective Studies
keywords: cirrhosis; drain placement; end-stage liver disease; indwelling catheters; peritoneal catheters; refractory ascites