Indwelling Peritoneal Catheters in Patients with Cirrhosis and Refractory Ascites Journal Article

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Authors: Kathpalia, P.; Bhatia, A.; Robertazzi, S.; Ahn, J.; Cohen, S. M.; Sontag, S.; Luke, A; Durazo-Arvizu, R; Pillai, A. A.; Public Health Sciences
Article Title: Indwelling Peritoneal Catheters in Patients with Cirrhosis and Refractory Ascites
Abstract: INTRODUCTION: The prevalence of spontaneous bacterial peritonitis (SBP) in hospitalized cirrhotics with ascites is 10-30%. Treatment for refractory ascites includes paracenteses, TIPS, or drain placement; latter is discouraged due to a perceived infection risk. AIMS: To evaluate the risk of bacterial peritonitis (BP) with peritoneal drains in patients with Child Pugh Class B or C cirrhosis and determine their impact on survival. METHODS: We conducted a retrospective review of end stage liver disease (ESLD) patients with non-malignant, refractory ascites who had peritoneal drains placed for >/= 3 days at Loyola University between 1999-2009. Cell counts were performed at drain placement and within 72 hours. BP was defined as ascitic PMNs >250/mm3 . Univariate analysis assessed association between demographics, laboratory markers, and development of BP. Kaplan-Meier curve estimates by infection were constructed and survival distributions compared using Log-Rank statistic. RESULTS: There were 227 drain placements during the study period. Twenty-two percent were diagnosed with BP (12% had SBP at drain placement; 10% developed BP within 72 hours). There was no association between BP and baseline characteristics. Patients who developed BP within 72 hours of drain placement had 50% mortality at 5 months compared to 50 months in those without infection (Log-rank p = 0.003). CONCLUSION: In ESLD patients who received an indwelling peritoneal catheter, there was 10% risk of developing BP and significant mortality increase. Though placing drains is not the mainstay of treatment for refractory ascites, we confirm the theoretical adverse risk of peritoneal drains on infection and survival in cirrhotics.
Journal Title: Internal Medicine Journal
Volume: 45
Issue: 10
ISSN: 1445-5994; 1444-0903
Publisher: Unknown  
Date Published: 2015
Start Page: 1026
End Page: 1031
Language: ENG
DOI/URL:

10.1111/imj.12843
Notes: LR: 20150701; CI: This article is protected by copyright. All rights reserved.; JID: 101092952; OTO: NOTNLM; 2015/06/15 [accepted]; aheadofprint