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Early paracentesis lowers re-admission rates in patients with ascites related to cirrhosis

In a retrospective cohort study, researchers found that early paracentesis in patients with new onset ascites related to cirrhosis lowers 30-day re-admission rates. In addition, early initiation of diuretic therapy lowers 90-day mortality, according to published findings.

Medical records of 302 patients admitted to Monash Health, Melbourne, Australia, with new onset ascites due to cirrhosis were collected and reviewed to determine if eight Delphi panel-derived quality indicators (QI) made any impact on clinical endpoints and ascites management. Analyses were performed to find associations between adherence to each QI (n = 8) and 30-day hospital re-admission and 90-day mortality.

All patients were followed for a median of 12.2 months, with a median length of stay during their index admission of 1 week.

Overall, 29% of patients were re-admitted within 30 days (n = 87), with 65 admissions to the intensive care unit. A majority of patients were re-admitted within 90 days of index admission (70.86%). Of these, 41% required emergency re-admission within 30 days of discharge. The median time to re-admission was 58 days and most commonly due to recurrence of symptomatic ascites (n = 39), hepatic encephalopathy (HE; n = 15) and spontaneous bacterial peritonitis (SBP; n = 10).

The most significant independent risk factor for 90-day mortality was 30-day re-admission (P < .001), then pneumonia and long-term antibiotic use for primary SBP prophylaxis, a QI. Early receipt of diuretics, another QI, was also associated with lower 90-day mortality risk.

Due to complications of cirrhosis, 22.5% of patients required three or more emergent admissions per year of life.

The adherence of staff to each QI was between 70% and 92%, according to the research.

“In our cohort, specialist gastroenterology management was provided to 95% of patients, and all were referred for outpatient specialist management,” the researchers wrote. “Despite these measures, patients experienced early emergent re-admissions, frequent hospitalizations and high 90-day mortality. … Prospective studies are required to validate the clinical impact of these three QIs as part of a simplified ascites management algorithm.”

The overall mortality rate was 46.4%, of which 19.3% of deaths occurred within 30 days of the index admission and 40% occurred within 90 days of the index admission.

Common causes of mortality were pneumonia (n = 32), HE (n = 18), variceal hemorrhage (n = 16) and hepatocellular carcinoma (n = 16).

The mean number of abdominal paracenteses for each patient per year of follow-up was 2.6.

The researchers concluded: “The current paradigm of care for patients with cirrhosis-related ascites fails to promote patient self-care and is highly dependent on health care resources. There is a need to redefine care goals and the mode of treatment delivery in order to attenuate the morbidity and mortality associated with cirrhosis-related ascites.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.