The predictors of survival in cirrhotic patients with hepatic hydrothorax

Objective: Hepatic hydrothorax is an uncommon complication of liver cirrhosis. The outcome of the patients is often poor. Multiple therapeutic options are available but there is no standard protocol of management. The predictors of survival are also indistinct. Material and Methods: This single-center study retrospectively reviewed the medical records of cirrhotic patients with hepatic hydrothorax from August 2006 to August 2011. The characteristics of the patients, treatment methods, outcome of management, and survival were analyzed. Results: Of the 48 patients, 26 (54.2%) were young age (< 65 years old) and 22 (45.8%) were elderly patients (³ 65 years old). Among all, 32 (66.7%) patients received only conservative treatments, including sodium restricted diet, medications, peritoneal paracentesis, and thoracentesis. The other 16 (33.3%) patients had received additional aggressive treatment, such as video-assisted thoracic surgery, chest tube thoracostomy with or without pleurodesis, and liver transplantation. We defined the initial treatment success as the symptoms were relieved in the absence of thoracentesis for at least three months post-treatment. Multivariate analysis showed initial treatment success and a MELD score < 18 are independent predictors of survival. Conclusions: For patients with liver cirrhosis and hepatic hydrothorax, despite their age and the methods for treatment, when resolution of the hydrothorax can be maintained for at least 3 months or when the patients have a MELD score < 18, the survival may improve.