Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 8, Number 3-4, August 2015, pages 228-233

Clinical Profile and Complications of Paracentesis in Refractory Ascites Patients With Cirrhosis

**Table 1.** Diagnostic Criteria of Refractory Ascites
Adapted from Moore et al.
1) Lack of response to maximal doses of diuretic for at least 1 week
2) Diuretic-induced complications in the absence of other precipitating factors
3) Early recurrence of ascites within 4 weeks of fluid mobilization
4) Persistent ascites despite sodium restriction
5) Mean weight loss < 0.8 kg over 4 days
6) Urinary sodium excretion less than sodium intake

Table 1. Diagnostic Criteria of Refractory Ascites

Adapted from Moore et al.

1) Lack of response to maximal doses of diuretic for at least 1 week

2) Diuretic-induced complications in the absence of other precipitating factors

3) Early recurrence of ascites within 4 weeks of fluid mobilization

4) Persistent ascites despite sodium restriction

5) Mean weight loss < 0.8 kg over 4 days

6) Urinary sodium excretion less than sodium intake

**Table 2.** Clinical Implications of Refractory Ascites
1) Dilutional hyponatremia
2) Hepatorenal syndrome
3) Spontaneous bacterial peritonitis
4) Hepatic hydrothorax
5) Spontaneous bacterial empyema
6) Umbilical hernia

Table 2. Clinical Implications of Refractory Ascites

1) Dilutional hyponatremia

2) Hepatorenal syndrome

3) Spontaneous bacterial peritonitis

4) Hepatic hydrothorax

5) Spontaneous bacterial empyema

6) Umbilical hernia

**Table 3.** Patient Characteristics
Category	Number (%)
Age, median (range)	56 (34 - 79)
Age category (years)
< 50	204 (17%)
50 - 59	602 (50.16%)
60 - 69	214 (17.83%)
70 - 79	198 (16.25%)
> 80	0
Gender
Male	1,183 (97.126%)
Female	35 (2.873%)
HbA1c, mean (available for 300 patients)	8.3 ± 2.09
HbA1c category
< 6%	29 (9.66%)
6-6.9%	60 (20%)
7-7.9%	120 (40%)
8-8.9%	69 (23%)
> 9%	22 (7.33%)
Diabetes duration > 10 years	100 (33.33%)
Dyslipidemia	1,080 (88.66%)
Abnormal LDL	1,019 (83.66%)
Abnormal HDL	721 (59.19%)
High total cholesterol	1,001 (82.18%)
Triglycerides	903 (74.13%)
Patients taking statins	404 (33.16%)

Table 3. Patient Characteristics

Category

Number (%)

Age, median (range)

56 (34 - 79)

Age category (years)

< 50

204 (17%)

50 - 59

602 (50.16%)

60 - 69

214 (17.83%)

70 - 79

198 (16.25%)

> 80

Gender

Male

1,183 (97.126%)

Female

35 (2.873%)

HbA1c, mean (available for 300 patients)

8.3 ± 2.09

HbA1c category

< 6%

29 (9.66%)

6-6.9%

60 (20%)

7-7.9%

120 (40%)

8-8.9%

69 (23%)

> 9%

22 (7.33%)

Diabetes duration > 10 years

100 (33.33%)

Dyslipidemia

1,080 (88.66%)

Abnormal LDL

1,019 (83.66%)

Abnormal HDL

721 (59.19%)

High total cholesterol

1,001 (82.18%)

Triglycerides

903 (74.13%)

Patients taking statins

404 (33.16%)

**Table 4.** Clinical and Laboratory Data
Age, years, median (range)	56 (34 - 79)
Sex	n (%)
Male	1,183 (97.126%)
Female	35 (2.873%)
Etiology	n (%)
Alcoholic	1,151 (94.49%) (F: 28; M: 1,123)
Hepatitis C-related	16 (1.313%) (F: 2; M: 14)
Hepatitis B-related	42 (3.448%) (F: 3; M: 39)
Cryptogenic	9 (0.738%) (F: 2; M: 7)
Serum albumin, g/dL	26 (14.3 - 38.0)
Serum bilirubin, μmol/L, median (range)	31 (3.0 - 304.0)
Serum creatinine, μmol/L, median (range)	87 (37 - 379)
INR, median (range)	1.5 (1.0 - 3.0)
Child-Pugh score, median (range)	10 (8 - 15)
Model for end-stage liver disease (MELD) score, median (range)	14.5 (6.2 - 28.9)

Table 4. Clinical and Laboratory Data

Age, years, median (range)

56 (34 - 79)

Sex

n (%)

Male

1,183 (97.126%)

Female

35 (2.873%)

Etiology

n (%)

Alcoholic

1,151 (94.49%) (F: 28; M: 1,123)

Hepatitis C-related

16 (1.313%) (F: 2; M: 14)

Hepatitis B-related

42 (3.448%) (F: 3; M: 39)

Cryptogenic

9 (0.738%) (F: 2; M: 7)

Serum albumin, g/dL

26 (14.3 - 38.0)

Serum bilirubin, μmol/L, median (range)

31 (3.0 - 304.0)

Serum creatinine, μmol/L, median (range)

87 (37 - 379)

INR, median (range)

1.5 (1.0 - 3.0)

Child-Pugh score, median (range)

10 (8 - 15)

Model for end-stage liver disease (MELD) score, median (range)

14.5 (6.2 - 28.9)

**Table 5.** Co-morbid Conditions in Patients
Co-morbidities	Number (%)
CKD	153 (12.56%)
IHD	209 (16.50%)
Cerebrovascular disease	104 (8.53%)
COPD	99 (8.12%)
≥ 2 co-morbidities	287 (23.56%)

Table 5. Co-morbid Conditions in Patients

Co-morbidities

Number (%)

CKD

153 (12.56%)

IHD

209 (16.50%)

Cerebrovascular disease

104 (8.53%)

COPD

99 (8.12%)

≥ 2 co-morbidities

287 (23.56%)

**Table 6.** Variables and Paracenteses Percentages
Calculated variables	Paracenteses (n = 4,389)
Early complications	n (%)
Incomplete drainage	69 (5.66%)
Pain at puncture site	57 (4.67%)
Local bleeding	35 (2.87%)
Hypotension	51 (4.18%)
Increased SOB	30 (2.46%)
Re-punctures done	32 (2.62%)
Slipping of catheter used for tapping	24 (1.97%)
Leakage of ascitic fluid from puncture site	39 (3.20%)
Total	337 (27.66%)
Late complications	n (%)
Fever	23 (1.88%)
Abdominal hematoma	30 (2.46%)
Hepatic encephalopathy	88 (7.22%)
Spontaneous bacterial peritonitis	32 (2.62%)
Hepatorenal syndrome	17 (1.39%)
Hepatopulmonary syndrome	15 (1.23%)
Mean volume ± SD of drained ascitic fluid, mL	4,900 ± 2,795 mL
Total	205 (16.83%)

Table 6. Variables and Paracenteses Percentages

Calculated variables

Paracenteses (n = 4,389)

Early complications

n (%)

Incomplete drainage

69 (5.66%)

Pain at puncture site

57 (4.67%)

Local bleeding

35 (2.87%)

Hypotension

51 (4.18%)

Increased SOB

30 (2.46%)

Re-punctures done

32 (2.62%)

Slipping of catheter used for tapping

24 (1.97%)

Leakage of ascitic fluid from puncture site

39 (3.20%)

Total

337 (27.66%)

Late complications

n (%)

Fever

23 (1.88%)

Abdominal hematoma

30 (2.46%)

Hepatic encephalopathy

88 (7.22%)

Spontaneous bacterial peritonitis

32 (2.62%)

Hepatorenal syndrome

17 (1.39%)

Hepatopulmonary syndrome

15 (1.23%)

Mean volume ± SD of drained ascitic fluid, mL

4,900 ± 2,795 mL

Total

205 (16.83%)

**Table 7.** Ascitic Tap Procedure Followed in the Study [11]
Explain the procedure to the patient, including risks, and obtain consent
Position the patient, usually in the supine position with the head of the bed elevated to allow fluid to accumulate in the patient’s lower abdomen
Position of the tap
Locate area of flank dullness lateral to the rectus abdominis muscle and go approximately 5 cm superior and medial to the anterior superior iliac spines
Avoid the inferior epigastric vessels which run up the side of the rectus abdominis to anastomose with the superior epigastric vessels coming down
Avoid the pelvic area, solid tumor masses, prominent superficial veins (caput medusa) and scars (may have collateral vessels close by or adherent bowel beneath)

Table 7. Ascitic Tap Procedure Followed in the Study [11]

Explain the procedure to the patient, including risks, and obtain consent

Position the patient, usually in the supine position with the head of the bed elevated to allow fluid to accumulate in the patient’s lower abdomen

Position of the tap

Locate area of flank dullness lateral to the rectus abdominis muscle and go approximately 5 cm superior and medial to the anterior superior iliac spines

Avoid the inferior epigastric vessels which run up the side of the rectus abdominis to anastomose with the superior epigastric vessels coming down

Avoid the pelvic area, solid tumor masses, prominent superficial veins (caput medusa) and scars (may have collateral vessels close by or adherent bowel beneath)