Introduction: There has been a significant change in outpatient cirrhosis care, as paracentesis is currently performed by interventional radiologists (IR) rather than gastroenterologists/hepatologists or internists. In this model of care, patients’ access could be limited by scheduling availability, and there is no evaluation of their renal function or adjustment of their medications at the time of paracentesis. This study was aimed to analyze hospital utilization and cirrhosis complications within six months of index outpatient paracentesis by IR and to identify potential areas of improvement in care.
Methods: This is a retrospective study of patients with cirrhosis and ascites who underwent outpatient paracentesis by IR from October 2015 to October 2018 at a tertiary academic medical center. We collected demographics, data on cirrhosis etiology/complications, laboratory tests, provider notes, outpatient paracenteses dates, emergency department (ED) visits, hospitalizations, and ICU admissions within the following six months post-index paracentesis. Overall survival was analyzed using product-limited survival estimates (Kaplan-Meier). The log-rank test was used to test for differences by cause. Kaplan-Meier survival curves were plotted for overall and stratified survival. Cox regression analyses examined survival by cause while controlling for age and MELD score. Hazard ratios are reported.
Results: Within 6 months from index paracentesis, 44 patients (64.7%) underwent repeat IR outpatient paracentesis (total 187 paracenteses, 4.25 paracenteses/patient); 42 (61.7%) had ER visits (total 118 ER visits, 2.8/patient), 40 (58.5%) had hospital admissions (total 88 admissions, 2.2/patient) and 11 had ICU admission. On multivariate analysis, the predictive factors for mortality were older age (p=0.04) and MELD score (p=0.082). Baseline MELD was predictive of acute kidney injury (p=0.0184), UGI bleed (p=0.0096), and ICU admission (p=0.0064). The mean overall survival was 35.6 (SD +/- 2.68) months. Mean survival stratified by cause was 36.2 (SD +/- 3.78) months for patients with cirrhosis due to alcohol use, and 41.7 (SD +/- 4.1) months for cirrhosis due to hepatitis B or C.
Discussion: In this contemporary cohort of patients with cirrhosis undergoing IR outpatient paracentesis, we found a high rate of short-term cirrhosis complications and hospital utilization, while TIPS consideration was very low. Further data is needed to identify specific gaps in care and to analyze long-term survival.
