Presence of parietal edema increases risk of ascitic fluid leak after paracentesis in liver cirrhosis patients

Ascites is the frequently occurring complication of decompensated liver cirrhosis requiring diagnostic, therapeutic purposes. In patients with cirrhosis, an ascitic fluid leak can develop after paracentesis, leading to significant morbidity if persistent. Suprabhat Giri, Seth GS Medical College, and KEM Hospital, Mumbai, India, and colleagues, therefore, aimed to study the predictors and incidence of post-paracentesis leak in ascites patients in a prospective study.

For this purpose, the researchers followed cirrhosis patients undergoing therapeutic paracentesis, and those who developed persistent leaks were taken as cases. Random control selection was made in the ratio of 2:1 among the patient group who did not develop leaks. Laboratory and clinical parameters were compared among the two groups.

The study led to the following findings:

· A total of 256 patients underwent 1126 sessions of therapeutic abdominal paracentesis over 14 months.

· Post-paracentesis leak was seen in 4.8% of patients, while only 1.7% had persistent leaks.

· The leak management was stepwise, initially with tincture benzoine with tight dressing followed by topical cyanoacrylate adhesive and autologous blood patch in those not responding.

· Patients with persistent leaks had a higher proportion of patients with parietal edema, higher PT-INR and Child-Pugh scores and lower mid-upper arm circumference, short physical performance battery score, and hand-grip strength.

· On multivariate analysis, only the presence of parietal edema was an independent predictor of post-paracentesis persistent leak (Odds ratio 10.35).

"When available during large-volume paracentesis (LVP), ultrasound guidance should be considered for reducing the risk of adverse events," the researchers wrote in their study. "Parietal edema presence increases patient's risk for developing an ascitic fluid leak. Hence, the leak incidence can be reduced by the mobilization of the edema by manual pressure before needle insertion by Z-technique."

"A stepwise approach involving injection and topical therapy can be used for managing patients developing an ascitic fluid leak," they concluded.

Reference:

The "Post-Paracentesis Ascitic Fluid Leak in Patients with Cirrhosis of Liver and its Management: A Prospective Study" was published in the Journal of Clinical and Experimental Hepatology.

DOI: https://doi.org/10.1016/j.jceh.2022.10.007