Analysis of factors associated with the prognosis of cirrhotic patients who were treated with tolvaptan for hepatic edema

Background and Aim The prognosis of cirrhotic patients with hepatic edema is poor. Although several short‐term predictors of tolvaptan (novel diuretic agent) treatment for such patients have been reported, the factors related to long‐term survival are still unclear. Methods Among 459 patients with hepatic edema enrolled in a retrospective, multicenter collaborative study, we analyzed 407 patients who received tolvaptan. Results Patients consisted of 266 men and 141 women, with the median age of 68 years (range, 28–93 years). The frequency of short‐term responders to tolvaptan was 59.7% (243/407). In the Cox regression analysis, short‐term response to tolvaptan, low average dosages of furosemide and spironolactone during tolvaptan treatment, Child–Pugh classification A and B, and absence of hepatocellular carcinoma were independent factors contributed to 1‐year survival. The 1‐year and long‐term cumulative survival rates in short‐term responders were significantly higher than those in non‐responders (P = 0.011 and 0.010, respectively). Using a receiver operating characteristic curve analysis, the optimal cut‐off values of average daily dosages of furosemide and spironolactone for predicting 1‐year survival were 19 and 23 mg/day, respectively. The long‐term cumulative survival rates in patients who received a mean dosage of spironolactone