Yonsei Med J.  2013 Jan;54(1):145-153. 10.3349/ymj.2013.54.1.145.

Predictors of Refractory Ascites Development in Patients with Hepatitis B Virus-Related Cirrhosis Hospitalized to Control Ascitic Decompensation

• Seo JH
• Kim SU
• Park JY
• Kim DY
• Han KH
• Chon CY
• Ahn SH

• KMID: 1776930
• DOI: http://doi.org/10.3349/ymj.2013.54.1.145

Abstract

PURPOSE
Refractory ascites (RA) is closely related to a high morbidity and mortality. In this study, we investigated predictors of RA development in patients with hepatitis B virus (HBV)-related cirrhosis who were hospitalized to control ascitic decompensation, and determined predictors for survival in patients who experienced RA.
MATERIALS AND METHODS
We analyzed 199 consecutive patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation between January 1996 and December 2008.
RESULTS
Multivariate analyses showed that only serum potassium at admission predicted RA development independently [p=0.013; hazard ratio (HR), 2.800; 95% confidence interval (CI), 1.166-6.722]. During the follow-up period, 16 (8.0%) patients experienced RA within 4.2 (range, 1.0-39.2) months after admission for controlling ascitic decompensation, and they survived a median of 8.7 (range, 3.9-51.3) months. Child-Pugh class and RA type were identified as independent prognostic factors affecting the survival in patients with RA (p=0.045; HR, 8.079; 95% CI, 1.231-67.984 and p=0.013; HR, 14.510; 95% CI, 1.771-118.874, respectively).
CONCLUSION
Serum potassium was an independent predictor of RA development in patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation. After RA development, Child-Pugh class and RA type were independent predictors for survival.

Keyword

Ascites; chronic hepatitis B; cirrhosis; predictor; refractory; survival

MeSH Terms

Adult
Aged
Ascites/complications/*diagnosis/mortality
Female
Hepatitis B, Chronic/complications/mortality/*therapy
Hospitalization
Humans
Liver Cirrhosis/complications/mortality/*therapy
Liver Transplantation
Male
Middle Aged
Multivariate Analysis
Potassium/blood
Prognosis
Retrospective Studies
Treatment Outcome
Potassium

Figure

• 

  Fig. 1 Kaplan-Meier estimate of RA development according to serum potassium levels in patients with HBV-related cirrhosis who were hospitalized to control ascitic decompensation. The incidence of RA is significantly higher in patients with serum potassium ≥4.1 mEq/L than in those with <4.1 mEq/L. RA, refractory ascites; HBV, hepatitis B virus.

• 

  Fig. 2 The cumulative survival rates according to Child-Pugh class in patients with RA. The median survival of patients with Child-Pugh B is significantly better than those with Child-Pugh C [median 13.9 months (range, 7.5-51.3) vs. 8.3 months (range, 3.9-39.8); log-rank test, p=0.034]. RA, refractory ascites.

• 

  Fig. 3 The cumulative survival rates according to RA type in patients with RA. The median survival of patients with diuretic-resistant type RA is significantly better than those with diuretic-intractable type RA [median 13.9 months (range, 4.1-51.3) vs. 5.6 months (range, 3.9-8.7); log-rank test, p=0.002]. RA, refractory ascites.

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