Background & Aims
Hemorrhagic ascites can pose diagnostic and therapeutic dilemmas in patients with
cirrhosis. We aimed at exploring the characteristics and outcomes of patients with
cirrhosis and hemorrhagic ascites.
Methods
The records of all patients with cirrhosis and ascites, who underwent paracentesis
between 2003 and 2010 at Parkland Memorial Hospital, were retrospectively reviewed.
Hemorrhagic ascites was defined as an ascitic fluid red blood cell (RBC) count ⩾10,000/μl.
We compared each patient with 3 age- and gender-matched controls (cirrhotic patients
with ascites and an ascitic RBC count <10,000/μl). Survival curves were generated
using Kaplan–Meier plots and compared using the log rank test.
Results
1113 cirrhotic patients underwent paracentesis; 214 (19%) had hemorrhagic ascites.
Patients with hemorrhagic ascites had higher rates of spontaneous bacterial peritonitis
(p <0.001), acute kidney injury (AKI, p <0.001), and were more likely to require intensive care unit (ICU)-level care (p = 0.01) compared to patients without hemorrhagic ascites. Patients with hemorrhagic
ascites had a higher mortality than controls at one month (87% vs. 72%), 1 year (72% vs. 50%) and 3 years (61% vs. 41%). Using multivariate regression analysis, hemorrhagic ascites was also an independent
predictor of mortality (HR 1.34, 95% CI 1.07–1.68) after adjusting for the model for
end-stage liver disease score (HR 1.04, 1.03–1.05), ICU-level care (HR 2.02, 1.63–2.51)
and presence of hepatocellular carcinoma (HR 2.27, 1.61–3.19).
Conclusions
Patients with hemorrhagic ascites had a significantly higher rate of ICU care, AKI,
and mortality than patients with portal hypertension and ascites but without hemorrhagic
ascites. We conclude that hemorrhagic ascites is a marker of advanced liver disease
and poor outcome.
Abbreviations:
RBC (red blood cell), AKI (acute kidney injury), MELD (Model for End-Stage Liver Disease), INR (international normalized ratio), HCC (hepatocellular carcinoma), HCV (hepatitis C virus), HBV (hepatitis B virus), SBP (spontaneous bacterial peritonitis), SIRS (systemic inflammatory response syndrome)Keywords
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Article info
Publication history
Published online: January 23, 2013
Accepted:
January 10,
2013
Received in revised form:
December 3,
2012
Received:
July 26,
2012
Identification
Copyright
© 2013 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
