Early vs. late paracentesis associated with better outcomes in hospitalized cirrhosis patients
Patients hospitalized with cirrhosis and ascites who received diagnostic paracentesis within 12 to 24 hours of admission had lower rates of in-hospital mortality and acute kidney injury and shorter length of stay than those who received it later, a meta-analysis found.
Patients admitted to the hospital with cirrhosis and ascites may do better if they receive paracentesis early, a recent study found.
Researchers performed a systematic review and meta-analysis to evaluate outcomes in hospitalized patients with cirrhosis and ascites who received early versus delayed diagnostic paracentesis. Diagnostic paracentesis was considered early if it was received within 12 to 24 hours of admission. The primary outcome was in-hospital mortality, while secondary outcomes were length of hospital stay, acute kidney injury, and 30-day readmission. Results were published June 25 by the American Journal of Gastroenterology.
The analysis included seven retrospective cohort studies involving 78,744 patients, of whom 45,533 received early diagnostic paracentesis and 33,211 delayed. Six studies were conducted in the U.S., and one was conducted in Romania. Early diagnostic paracentesis versus delayed was associated with lower in-hospital mortality rates (odds ratio [OR], 0.61 [95% CI, 0.46 to 0.82]; P=0.001), shorter hospital stay (mean difference, −4.85 d [95% CI, −6.45 to −3.20 d]; P<0.001), and lower risk for acute kidney injury (OR, 0.62 [95% CI, 0.42 to 0.92]; P=0.02). Rates of 30-day readmission were similar between groups (OR, 1.11 [95% CI, 0.52 to 2.39]; P=0.79). In subgroup analysis, the benefit for in-hospital mortality was consistent with early diagnostic paracentesis performed within 12 hours or within 24 hours of admission (ORs, 0.51 [95% CI, 0.32 to 0.79; P=0.003] and 0.67 [95% CI, 0.45 to 0.98; P=0.04], respectively).
All of the included studies were observational, and all outcomes had significant statistical heterogeneity, among other limitations, the study authors noted. They concluded that diagnostic paracentesis within 12 to 24 hours of admission was associated with lower rates of in-hospital mortality and acute kidney injury, shorter length of stay, and similar rates of 30-day readmission compared with delayed diagnostic paracentesis in hospitalized patients with cirrhosis and ascites.
"Early diagnostic paracentesis within 12 hours of admission may be associated with the greatest mortality benefit," the authors wrote. "Large-scale [randomized controlled trials] are needed to validate our findings, especially if there is a greater benefit for early diagnostic paracentesis within 12 hours. Future research should also identify and address the obstacles to this important quality indicator to improve the outcomes of patients with cirrhosis and ascites."