Paracentesis via ultrasound decreases mortality in hospitalized patients with cirrhosis

Hospitalized patients with cirrhosis who underwent paracentesis via ultrasound had increased mortality benefit over time, according to findings presented at the Society of Hospital Medicine Annual Meeting.

“The prevalence of paracentesis related complications is not well characterized, but prior studies suggest improved safety outcomes when ultrasound guidance is employed … [we used] PSI 27 codes and validated renal codes to comprehensively assess the prevalence of paracentesis-related complications via the Nationwide Inpatient Sample [database],” Alex R. Montero, MD, MPH, assistant program director for quality and safety, Georgetown University Hospital, Washington, D.C., and colleagues wrote.

Alex R. Montero

The researchers evaluated data of 32,418 patients hospitalized across the U.S. between 2004 and 2012 with a primary diagnosis of ascites, spontaneous bacterial peritonitis or hepatic encephalopathy. In addition, all patients had a secondary diagnosis of cirrhosis.

Overall, 56.3% (n = 18,275) of hospitalized patients underwent paracentesis. Between 2004 and 2012, there was a 10% increase in patients receiving paracentesis while hospitalized (50.1% vs. 60.7%; P < .0001).

Analysis showed mortality was lower in patients who underwent paracentesis (6.37%) compared with patients who did not (8.1%; P < .0001). Length of hospital stay was also longer in patients who received paracentesis (6.6 days) compared with those who did not (5.3 days; P < .0001). Abdominal hematoma and hemoperitoneum were bleeding complications experienced by patients who underwent paracentesis. Adverse renal outcomes, such as acute kidney injury, were more common in the same population (26.1%) compared with those who did not undergo paracentesis (17.5%; P < .0001).

Multivariable regression models showed the mortality benefit of paracentesis remained, but was “slightly attenuated” by the acute kidney injury, according to the abstract.

“Our study confirmed a mortality benefit from paracentesis in hospitalized patients eligible for paracentesis, and this benefit became more pronounced over time,” the researchers concluded. “Although underutilized, paracentesis has become more prevalent in recent years. The increasing use of ultrasound guided paracentesis may explain both of these findings — ultrasound guidance should be employed whenever possible.” – by Melinda Stevens

Reference:

Chang J, et al. Abstract #204. Presented at: Society of Hospital Medicine Annual Meeting; March 6-9, 2016; San Diego.

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