title: Clinical characteristics and outcome of cirrhotic patients with high protein concentrations in ascites: a prospective study.
abstract: BACKGROUND
  The protein concentration in ascites is usually low in cirrhosis because capillarization and defenestration of the sinusoids limit diffusion of large proteins from plasma to the space of Disse. However, some cirrhotic patients have high-protein ascites (HPA).
  
  
  OBJECTIVE
  The aim of this study was to describe and compare the characteristics and prognosis between cirrhotic patients with HPA (>20 g/l) and patients with low-protein ascites (LPA).
  
  
  METHODS
  In this longitudinal observational prospective cohort study, all consecutive cirrhotic patients with ascites hospitalized in our tertiary liver center were included and followed for up to 2 years, provided that they had no other cause of HPA. HPA was defined as protein concentrations of more than 20 g/l.
  
  
  RESULTS
  Among 107 patients included, 19 (17.8%) had HPA. HPA patients had more refractory ascites (63 vs. 34%), better liver functions, and a higher 1-year transplant-free survival rate compared with LPA patients (P<0.05). Portal hypertension parameters were not different. During follow-up, 47% of HPA patients were treated by transjugular intrahepatic portosystemic shunts versus 18% of LPA patients, whereas 15 LPA patients required liver transplantation for end-stage liver disease versus only one HPA patient. We observed higher protein filtration and less pericellular, centrilobular, and sinusoidal fibrosis in cirrhotic HPA livers compared with LPA livers.
  
  
  CONCLUSIONS
  Almost 20% of cirrhotic patients with ascites have HPA (>20 g/l). These patients have better liver functions and a higher 1-year survival than those with LPA, even though ascites are more often refractory.
authors.affiliation: aDepartment of Hepatology and Gastroenterology bDepartment of Anatomy and Cytopathology,Institut Universitaire du Cancer de Toulouse - Oncopole cDepartment of Radiology, University Hospital of Toulouse, University Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Maeva
authors.initials: M
authors.lastname: Guillaume
authors.forename: Marie-Angèle
authors.initials: MA
authors.lastname: Robic
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Péron
authors.forename: Janick
authors.initials: J
authors.lastname: Selves
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Estelle
authors.initials: E
authors.lastname: Sirach
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Vinel
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
mesh_terms: D000328:Adult; D001201:Ascites / Q000209:etiology* / Q000378:metabolism*; D001706:Biopsy; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D011446:Prospective Studies; D011506:Proteins / Q000032:analysis*
chemical_list: D011506:Proteins