Impact of therapeutic interventions on survival of patients with hepatic hydrothorax

Abstract

Background/purpose: Hepatic hydrothorax is an uncommon but important complication of liver cirrhosis. The optimal management of this condition remains unclear. This retrospective study evaluated the impact of therapeutic interventions on the outcome of patients with hepatic hydrothorax.

Methods: From August 1996 to March 2004, the medical charts of 52 patients with hepatic hydrothorax in the National Taiwan University Hospital were reviewed. Treatment methods, outcome of interventions, and survival time were described and analyzed.

Results: At the time of diagnosis, four patients were Child-Pugh class A, 20 were class B, and 28 were class C. Twenty-eight (53.8%) patients received supportive care with thoracentesis for symptom relief. Among the other 24 patients, 16 (30.8%) were treated by chemical pleurodesis, 14 (26.9%) underwent surgical interventions, and six (11.5%) received both interventions. Intervention success, defined as resolution of hydrothorax for at least 3 months after the procedure, was achieved in 37.5% and 42.9% of patients who underwent chemical pleurodesis and surgery, respectively, with an overall success rate of 50%. The median survival of all patients was 8.6 months (range, 0.2-77.6 months). The median survival of patients with intervention success (22.5 months) was significantly longer than those with intervention failure (5.4 months) and supportive care (6.3 months). Multivariate analysis showed that only intervention success (p = 0.010, hazard ratio = 0.25) was an independent predictor of survival.

Conclusion: For patients with hepatic hydrothorax, aggressive medical or surgical intervention might improve survival over supportive management, especially when resolution of hydrothorax can be maintained for at least 3 months.