Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis
Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter. Our aim was to assess the efficacy, mortality and c...
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| Veröffentlicht in: | Digestive and liver disease 2022-08, Vol.54 (8), p.1007-1014 |
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| container_title | Digestive and liver disease |
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| creator | Will, Valerie Rodrigues, Susana G Berzigotti, Annalisa |
| description | Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter.
Our aim was to assess the efficacy, mortality and complications of each treatment.
We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software.
Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I
=82.1; τ
= 0.37; p |
| doi_str_mv | 10.1016/j.dld.2021.12.007 |
| format | Article |
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Our aim was to assess the efficacy, mortality and complications of each treatment.
We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software.
Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I
=82.1; τ
= 0.37; p<0.001) with lower mortality in newer studies (26% vs. 44%). At 6 months, mortality in patients with alfapump® was 24% (95% CI 0.16-0.33, I
=0.00; τ
= 0.00; p = 0.83), 31% developed acute kidney injury (95% CI 0.18-0.48, I
=44.0; τ
= 0.22; p = 0.15). Mortality at 12 months was 44% (95% CI 32%-58%, I
=76.7, τ
= 0.44, p<0.001) in peritoneovenous shunts and 45% (95% CI 38%-53%, I
=61.4, τ
= 0.18, p = 0.003) in large volume paracentesis, respectively. Overall mortality in patients with permanent indwelling catheters was 66% (95% CI 33%-89%, I
=82.5, τ
= 1.57, p = 0.001).
Mortality in patients with transjugular intrahepatic portosystemic shunt was lower in newer studies, probably due to a better patient selection. Acute kidney injury was frequent in patients with alfapump®. Permanent indwelling catheters seemed to be a good option in a palliative setting.</description><identifier>ISSN: 1590-8658</identifier><identifier>EISSN: 1878-3562</identifier><identifier>DOI: 10.1016/j.dld.2021.12.007</identifier><identifier>PMID: 35016859</identifier><language>eng</language><publisher>Netherlands</publisher><ispartof>Digestive and liver disease, 2022-08, Vol.54 (8), p.1007-1014</ispartof><rights>Copyright © 2021. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c344t-bbda5bdc0858d7ff6c2d8ec7ed0c48e72c3757517a7f9a47ed65dd80b7289cf93</citedby><cites>FETCH-LOGICAL-c344t-bbda5bdc0858d7ff6c2d8ec7ed0c48e72c3757517a7f9a47ed65dd80b7289cf93</cites><orcidid>0000-0003-4562-9016</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35016859$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Will, Valerie</creatorcontrib><creatorcontrib>Rodrigues, Susana G</creatorcontrib><creatorcontrib>Berzigotti, Annalisa</creatorcontrib><title>Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis</title><title>Digestive and liver disease</title><addtitle>Dig Liver Dis</addtitle><description>Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter.
Our aim was to assess the efficacy, mortality and complications of each treatment.
We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software.
Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I
=82.1; τ
= 0.37; p<0.001) with lower mortality in newer studies (26% vs. 44%). At 6 months, mortality in patients with alfapump® was 24% (95% CI 0.16-0.33, I
=0.00; τ
= 0.00; p = 0.83), 31% developed acute kidney injury (95% CI 0.18-0.48, I
=44.0; τ
= 0.22; p = 0.15). Mortality at 12 months was 44% (95% CI 32%-58%, I
=76.7, τ
= 0.44, p<0.001) in peritoneovenous shunts and 45% (95% CI 38%-53%, I
=61.4, τ
= 0.18, p = 0.003) in large volume paracentesis, respectively. Overall mortality in patients with permanent indwelling catheters was 66% (95% CI 33%-89%, I
=82.5, τ
= 1.57, p = 0.001).
Mortality in patients with transjugular intrahepatic portosystemic shunt was lower in newer studies, probably due to a better patient selection. Acute kidney injury was frequent in patients with alfapump®. Permanent indwelling catheters seemed to be a good option in a palliative setting.</description><issn>1590-8658</issn><issn>1878-3562</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNo9kMtOwzAQRS0EolD4ADbISzYJthPHzrKqeEmV2MDacuyJcJRHsd2i_D2uWljN1ejckeYgdEdJTgmtHrvc9jZnhNGcspwQcYauqBQyK3jFzlPmNclkxeUCXYfQkQRWnFyiRcFTXfL6CnXrnfcwRhw96Dgc0rSNbhoDnlrsofXaxMnPWAfjIgTsRty7PXhsnPdfU3ABZ3iFwxwiDDo6k0p7Bz9YjxYPEHWmR93PibtBF63uA9ye5hJ9Pj99rF-zzfvL23q1yUxRljFrGqt5Yw2RXFrRtpVhVoIRYIkpJQhmCsEFp0KLttZl2lfcWkkawWRt2rpYoofj3a2fvncQohpcMND3eoRpFxSraM0oEYwllB5R46cQ0rdq692g_awoUQfFqlNJsTooVpSppDh17k_nd80A9r_x57T4BUdzeqE</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Will, Valerie</creator><creator>Rodrigues, Susana G</creator><creator>Berzigotti, Annalisa</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4562-9016</orcidid></search><sort><creationdate>20220801</creationdate><title>Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis</title><author>Will, Valerie ; Rodrigues, Susana G ; Berzigotti, Annalisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-bbda5bdc0858d7ff6c2d8ec7ed0c48e72c3757517a7f9a47ed65dd80b7289cf93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Will, Valerie</creatorcontrib><creatorcontrib>Rodrigues, Susana G</creatorcontrib><creatorcontrib>Berzigotti, Annalisa</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive and liver disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Will, Valerie</au><au>Rodrigues, Susana G</au><au>Berzigotti, Annalisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis</atitle><jtitle>Digestive and liver disease</jtitle><addtitle>Dig Liver Dis</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>54</volume><issue>8</issue><spage>1007</spage><epage>1014</epage><pages>1007-1014</pages><issn>1590-8658</issn><eissn>1878-3562</eissn><abstract>Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter.
Our aim was to assess the efficacy, mortality and complications of each treatment.
We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software.
Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I
=82.1; τ
= 0.37; p<0.001) with lower mortality in newer studies (26% vs. 44%). At 6 months, mortality in patients with alfapump® was 24% (95% CI 0.16-0.33, I
=0.00; τ
= 0.00; p = 0.83), 31% developed acute kidney injury (95% CI 0.18-0.48, I
=44.0; τ
= 0.22; p = 0.15). Mortality at 12 months was 44% (95% CI 32%-58%, I
=76.7, τ
= 0.44, p<0.001) in peritoneovenous shunts and 45% (95% CI 38%-53%, I
=61.4, τ
= 0.18, p = 0.003) in large volume paracentesis, respectively. Overall mortality in patients with permanent indwelling catheters was 66% (95% CI 33%-89%, I
=82.5, τ
= 1.57, p = 0.001).
Mortality in patients with transjugular intrahepatic portosystemic shunt was lower in newer studies, probably due to a better patient selection. Acute kidney injury was frequent in patients with alfapump®. Permanent indwelling catheters seemed to be a good option in a palliative setting.</abstract><cop>Netherlands</cop><pmid>35016859</pmid><doi>10.1016/j.dld.2021.12.007</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-4562-9016</orcidid><oa>free_for_read</oa></addata></record> |
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| title | Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis |
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