Predictors of refractory ascites development in patients with hepatitis B virus-related cirrhosis hospitalized to control ascitic decompensation

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.

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.