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The benefit of paracentesis on hospitalized adults with cirrhosis and ascites.
J Gastroenterol Hepatol. 2015 Dec 8;
Authors: Gaetano JN, Micic D, Aronsohn A, Reddy G, Te H, Reau NS, Jensen D
Abstract
BACKGROUND AND AIM: To assess paracentesis utilization and outcomes in hospitalized adults with cirrhosis and ascites.
METHODS: The 2011 Nationwide Inpatient Sample was used to identify adults, non-electively admitted with diagnoses of cirrhosis and ascites. The primary endpoint was in-hospital mortality. Variables included patient and hospital demographics, early (day 0 or 1) or late (day 2 or later) paracentesis, hepatic decompensation, and spontaneous bacterial peritonitis.
RESULTS: Out of 8,023,590 admissions, 31,614 met inclusion criteria. Among these hospitalizations, approximately 51% (16,133) underwent paracentesis. The overall in-hospital mortality rate was 7.6%. There was a significantly increased mortality among patients who did not undergo paracentesis (8.9% vs. 6.3%, p<.001). Patients who did not receive paracentesis died 1.83 times more often in the hospital than those patients who did receive paracentesis (95% CI 1.66-2.02). Patients undergoing early paracentesis showed a trend towards reduction in mortality (5.5% vs. 7.5%) compared to those undergoing late paracentesis. Patients admitted on a weekend demonstrated less frequent use of early paracentesis (50% weekend vs. 62% weekday) and demonstrated increased mortality (adjusted OR 1.12 95% CI 1.01-1.25). Among patients diagnosed with SBP, early paracentesis was associated with shorter LOS (7.55 vs. 11.45 days, p<.001) and decreased HC ($61,624 vs. $107,484, p<.001).
CONCLUSION: Paracentesis is under-utilized among cirrhotic patients presenting with ascites, and is associated with decreased in-hospital mortality. This data supports the use of paracentesis as a key inpatient quality measure among hospitalized adults with cirrhosis. Future studies are needed to investigate the barriers to paracentesis use on admission. This article is protected by copyright. All rights reserved.
PMID: 26642977 [PubMed - as supplied by publisher]