Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites

P. Kathpalia, A. Bhatia, S. Robertazzi, Joseph Ahn, S. M. Cohen, S. Sontag, A. Luke, R. Durazo-Arvizu, A. A. Pillai

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: The prevalence of spontaneous bacterial peritonitis (SBP) in hospitalised cirrhotics with ascites is 10-30%. Treatment for refractory ascites includes paracenteses, transjugular intrahepatic portosystemic shunt or drain placement; the latter is discouraged due to a perceived infection risk. Aim: This study aimed 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 and 2009. Cell counts were performed at drain placement and within 72h. BP was defined as ascitic polymorphonuclear neutrophils >250/mm3. Univariate analysis assessed the association between demographics, laboratory markers and development of BP. Kaplan-Meier curve estimates by infection were constructed and survival distributions were compared using log-rank statistic. Results: There were 227 drain placements during the study period. Twenty-two per cent were diagnosed with BP (12% had SBP at drain placement; 10% developed BP within 72h). There was no association between BP and baseline characteristics. Patients who developed BP within 72h of drain placement had 50% mortality at 5 months compared with 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.

Original languageEnglish (US)
Pages (from-to)1026-1031
Number of pages6
JournalInternal Medicine Journal
Volume45
Issue number10
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

Fingerprint

Indwelling Catheters
Peritonitis
Ascites
Fibrosis
End Stage Liver Disease
Infection
Survival
Transjugular Intrahepatic Portasystemic Shunt
Paracentesis
Mortality
Kaplan-Meier Estimate
Neutrophils
Cell Count
Biomarkers
Demography

Keywords

  • Cirrhosis
  • Drain placement
  • End-stage liver disease
  • Indwelling catheters
  • Peritoneal catheters
  • Refractory ascites

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Kathpalia, P., Bhatia, A., Robertazzi, S., Ahn, J., Cohen, S. M., Sontag, S., ... Pillai, A. A. (2015). Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites. Internal Medicine Journal, 45(10), 1026-1031. https://doi.org/10.1111/imj.12843

Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites. / Kathpalia, P.; Bhatia, A.; Robertazzi, S.; Ahn, Joseph; Cohen, S. M.; Sontag, S.; Luke, A.; Durazo-Arvizu, R.; Pillai, A. A.

In: Internal Medicine Journal, Vol. 45, No. 10, 01.10.2015, p. 1026-1031.

Research output: Contribution to journalArticle

Kathpalia, P, Bhatia, A, Robertazzi, S, Ahn, J, Cohen, SM, Sontag, S, Luke, A, Durazo-Arvizu, R & Pillai, AA 2015, 'Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites', Internal Medicine Journal, vol. 45, no. 10, pp. 1026-1031. https://doi.org/10.1111/imj.12843
Kathpalia, P. ; Bhatia, A. ; Robertazzi, S. ; Ahn, Joseph ; Cohen, S. M. ; Sontag, S. ; Luke, A. ; Durazo-Arvizu, R. ; Pillai, A. A. / Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites. In: Internal Medicine Journal. 2015 ; Vol. 45, No. 10. pp. 1026-1031.
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abstract = "Background: The prevalence of spontaneous bacterial peritonitis (SBP) in hospitalised cirrhotics with ascites is 10-30{\%}. Treatment for refractory ascites includes paracenteses, transjugular intrahepatic portosystemic shunt or drain placement; the latter is discouraged due to a perceived infection risk. Aim: This study aimed 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 and 2009. Cell counts were performed at drain placement and within 72h. BP was defined as ascitic polymorphonuclear neutrophils >250/mm3. Univariate analysis assessed the association between demographics, laboratory markers and development of BP. Kaplan-Meier curve estimates by infection were constructed and survival distributions were compared using log-rank statistic. Results: There were 227 drain placements during the study period. Twenty-two per cent were diagnosed with BP (12{\%} had SBP at drain placement; 10{\%} developed BP within 72h). There was no association between BP and baseline characteristics. Patients who developed BP within 72h of drain placement had 50{\%} mortality at 5 months compared with 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.",
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T1 - Indwelling peritoneal catheters in patients with cirrhosis and refractory ascites

AU - Kathpalia, P.

AU - Bhatia, A.

AU - Robertazzi, S.

AU - Ahn, Joseph

AU - Cohen, S. M.

AU - Sontag, S.

AU - Luke, A.

AU - Durazo-Arvizu, R.

AU - Pillai, A. A.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background: The prevalence of spontaneous bacterial peritonitis (SBP) in hospitalised cirrhotics with ascites is 10-30%. Treatment for refractory ascites includes paracenteses, transjugular intrahepatic portosystemic shunt or drain placement; the latter is discouraged due to a perceived infection risk. Aim: This study aimed 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 and 2009. Cell counts were performed at drain placement and within 72h. BP was defined as ascitic polymorphonuclear neutrophils >250/mm3. Univariate analysis assessed the association between demographics, laboratory markers and development of BP. Kaplan-Meier curve estimates by infection were constructed and survival distributions were compared using log-rank statistic. Results: There were 227 drain placements during the study period. Twenty-two per cent were diagnosed with BP (12% had SBP at drain placement; 10% developed BP within 72h). There was no association between BP and baseline characteristics. Patients who developed BP within 72h of drain placement had 50% mortality at 5 months compared with 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.

AB - Background: The prevalence of spontaneous bacterial peritonitis (SBP) in hospitalised cirrhotics with ascites is 10-30%. Treatment for refractory ascites includes paracenteses, transjugular intrahepatic portosystemic shunt or drain placement; the latter is discouraged due to a perceived infection risk. Aim: This study aimed 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 and 2009. Cell counts were performed at drain placement and within 72h. BP was defined as ascitic polymorphonuclear neutrophils >250/mm3. Univariate analysis assessed the association between demographics, laboratory markers and development of BP. Kaplan-Meier curve estimates by infection were constructed and survival distributions were compared using log-rank statistic. Results: There were 227 drain placements during the study period. Twenty-two per cent were diagnosed with BP (12% had SBP at drain placement; 10% developed BP within 72h). There was no association between BP and baseline characteristics. Patients who developed BP within 72h of drain placement had 50% mortality at 5 months compared with 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.

KW - Cirrhosis

KW - Drain placement

KW - End-stage liver disease

KW - Indwelling catheters

KW - Peritoneal catheters

KW - Refractory ascites

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