Repeat Thoracentesis in Hepatic Hydrothorax and Non-Hepatic Hydrothorax Effusions: A Case-Control Study

Abstract

Background: Repeat thoracentesis for symptom control is offered to patients with refractory hepatic hydrothorax (HH) but the risk profile for this management strategy remains unclear. Objectives: This study aimed to compare complication frequency and nature during repeat thoracentesis in patients with and without HH. Methods: Complication rates in patients undergoing repeat thoracentesis for symptom relief was compared between patients with HH and a control group (non-HH group) at a single center from 2010 to 2015. Records were reviewed for demographics, laboratory values, number of thoracentesis, and associated complications with each procedure. Results: 82 patients with HH (274 thoracenteses) and 100 control patients (188 thoracenteses) were included. A complication was noted in 17/462 (0.03%) procedures in the entire cohort. There was a higher overall complication rate with repeat thoracentesis in the HH group (8 vs. 0%, p = 0.016, 95% CI = 1.5–14.6). In the HH group, the cumulative risk of complications increased with sequential thoracenteses; a complication occurring in the preceding intervention was the strongest predictor for subsequent complication (OR = 17.1, p = 0.0013) and more than 1 previous complication was associated with a 15-fold increased risk of a subsequent complication (p < 0.001). In multivariate analysis within the HH group, the Model for End-Stage Liver Disease (MELD) score was an independent predictor of hemothorax (OR = 1.19, 95% CI = 1.03–1.36, p = 0.012). Conclusions: Repeat thoracentesis is an overall low-risk procedure, although a higher complication rate is observed in HH compared with non-HH patients. The presence of a previous complication significantly increases the risk of future complications in the HH population.

Indwelling Tunneled Pleural Catheters for Refractory Hepatic Hydrothorax in Patients With Cirrhosis

“…Refractory HH often requires repeat thoracentesis, which carries a higher complication rate in this population. 16 TIPS has been used in the management of refractory HH in appropriate candidates; however, complete response is reported in 55% of patients. The reminder of patients will continue to require repeat thoracentesis for palliation or until liver transplant becomes an option.…”

Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence‐Based Review and Guidance

“…Having a previous complication significantly increased the risk of future complications (odds ratio, 15; P < 0.001). ( 13 )…”

A difficult pleural effusion in a cirrhotic patient

“…Thoracocentesis has a very low complication rate, with a pneumothorax rate of 0.6-6% and haemothorax rate of 0-2% [5]. Shojaee et al [6] described a case-control study of 82 patients with hepatic hydrothorax (274 thoracenteses) and 100 control patients (188 thoracenteses). There was a higher overall complication rate with repeat thoracocentesis in the hepatic hydrothorax group (8% versus 0%, p=0.016; 95% CI 1.5-14.6%) and that the cumulative risk of complications increased with sequential procedures.…”

“…Fluid leaking around the sites of procedures for ascitic fluid and hepatic hydrothorax is extremely common due poor wound healing and low albumin levels [6,11]. Fluid and protein loss is a major concern with drainage of ascites, and intravenous human albumin is routinely administered.…”