Ascites natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

More than half of the patients with cirrhosis would involve with ascites during the disease. If left untreated, 11.4% of patients with cirrhotic ascites may progress to develop hepatorenal syndrome during 5 years. Common complications of ascites include spontaneous bacterial peritonitis (SBP), dilutional hyponatremia, and hepatorenal syndrome. Prognosis is generally poor, and the 5-year survival rate of patients with cirrhotic ascites is approximately 56.6%.

Ascites may contribute to three grades:^[1]

Grade 1: Mild accumulation of fluid in abdomen, which is only visible on ultrasound.
Grade 2: Moderate accumulation of fluid in abdomen, which is detectable with flank bulging and shifting dullness.
Grade 3: Severe accumulation of fluid in abdomen, which is directly visible with fluid thrill.

More than half of the patients with cirrhosis would involve with ascites during the disease.
The symptoms of refractory ascites typically develop in 11.3% of patients during 5 years of cirrhosis.
If left untreated, 37.1% of patients with cirrhotic ascites may progress to develop dilutional hyponatremia during 5 years.
If left untreated, 11.4% of patients with cirrhotic ascites may progress to develop hepatorenal syndrome during 5 years.^[2]

Prognosis is generally poor, and the 5-year survival rate of patients with cirrhotic ascites is approximately 56.6%.
The presence of spontaneous bacterial peritonitis (SBP), dilutional hyponatremia, and hepatorenal syndrome is associated with a particularly poor prognosis among patients with cirrhotic ascites.^[2]

↑ Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, Angeli P, Porayko M, Moreau R, Garcia-Tsao G, Jimenez W, Planas R, Arroyo V. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003;38:258-66. PMID 12830009.
↑ ^2.0 ^2.1 Planas R, Montoliu S, Ballesté B, Rivera M, Miquel M, Masnou H, Galeras JA, Giménez MD, Santos J, Cirera I, Morillas RM, Coll S, Solà R (2006). "Natural history of patients hospitalized for management of cirrhotic ascites". Clin. Gastroenterol. Hepatol. 4 (11): 1385–94. doi:10.1016/j.cgh.2006.08.007. PMID 17081806.
↑ Pedersen JS, Bendtsen F, Møller S (2015). "Management of cirrhotic ascites". Ther Adv Chronic Dis. 6 (3): 124–37. doi:10.1177/2040622315580069. PMC 4416972. PMID 25954497.