title: Prognosis of refractory ascites in cirrhosis.
abstract: BACKGROUND
  Ascitic decompensation is a common major complication of cirrhosis and is associated with a poor outcome. In 5-10% of patients, ascites become resistant to treatment (either do not respond to a high dose of diuretics or because these drugs induce complications), which is called refractory ascites (RA). RA is associated with poor survival: 20-50% at 1 year. The aim of this study was to investigate the outcome of RA.
  
  
  METHODS
  Retrospective study including consecutive cirrhotic patients admitted for controlling ascites between January 2010 and April 2013. Patients and cirrhosis characteristics were studied. Development of RA during follow-up was investigated. The impact of RA on the outcome (cirrhosis complications and survival) was evaluated.
  
  
  RESULTS
  We included 124 cirrhotic patients: 59 females (47.6%); mean age was 58 years. Ascites was grade 3 in 38.5% and was the first episode in 45.1% of patients. Etiology of cirrhosis was mainly viral (57.3%). Child-Pugh score was B in 39.5% and C in 28.2%. Mean MELD score was 16 [6-40]. During follow-up, 27 patients developed RA, meaning a prevalence of 21.8%. RA type was diuretic intractable in all cases. Survival without complications was significantly reduced in patients with RA (4 vs 17 monthsp<10-3). RA was an independent predictive factor of global complications, spontaneous bacterial peritonitis and hepatic encephalopathy. Global survival was reduced in patients with RA (12 vs 16 months, p=0.069). One year survival was 45% for patients with RA vs 63% for other cirrhotics. In multivariate analysis, only Child-Pugh score, but not RA was an independent prognostic factor.
  
  
  CONCLUSIONS
  In this Tunisian sample we confirm that RA reduces survival and increases risk of cirrhosis complications, especially hepatic encephalopathy and spontaneous bacterial peritonitis. Therefore, these patients should be promptly listed for liver transplantation, over and above the MELD score.
authors.forename: Rym
authors.initials: R
authors.lastname: Ennaifer
authors.forename: Nour
authors.initials: N
authors.lastname: Elleuch
authors.forename: Hayfa
authors.initials: H
authors.lastname: Romdhane
authors.forename: Rania
authors.initials: R
authors.lastname: Hefaiedh
authors.forename: Maryem
authors.initials: M
authors.lastname: Cheikh
authors.forename: Sonda
authors.initials: S
authors.lastname: Chaabouni
authors.forename: Houda
authors.initials: H
authors.lastname: Ben Nejma
authors.forename: Najet
authors.initials: N
authors.lastname: Bel Hadj
mesh_terms: D001201:Ascites / Q000188:drug therapy / Q000209:etiology*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D004232:Diuretics