ABSTRACT
Uncontrolled studies suggest that transjugular intrahepatic portal-systemic shunting (TIPS) may improve quality of life in patients with refractory ascites. We hypothesized that any improvement of quality of life in patients with TIPS would be matched in controls due to the competing effects of improved ascites and worsened hepatic encephalopathy. Thus, an analysis of quality of life was performed using original data from the North American Study for the Treatment of Refractory Ascites, a multicenter trial of 109 patients randomized to TIPS or repeated large volume paracentesis (LVP) for refractory ascites. Short form 36 (SF-36) surveys were completed at baseline and at 6- and 12-month follow-up. Variables analyzed were: randomization group, number of LVP performed, cumulative volume from LVP, shortness of breath, abdominal distention, abdominal pain, diuretic usage, confusion, hospitalizations, and emergency room visits. Outcomes were changes in physical component scale (PCS) and mental component scale (MCS) of SF-36 results. We constructed multivariable, mixed effects models, including randomization group and baseline MCS and PCS. Changes in PCS and MCS from baseline were similar between the two randomization groups. In multivariate analysis, PCS improvement was associated with lack of confusion, improved ascites, and lack of hospitalizations, but not directly with randomization group. Improvement in MCS was associated with randomization to TIPS and lack of confusion. In conclusion, patients with refractory ascites randomized to TIPS or repeated LVP had similar changes in quality of life. Competing effects of hepatic encephalopathy, requirement for repeated LVP, and need for hospitalizations explain similar changes in quality of life between the two groups.
Subject(s)
Ascites/drug therapy , Ascites/surgery , Paracentesis , Portasystemic Shunt, Transjugular Intrahepatic , Quality of Life , Analysis of Variance , Ascites/psychology , Ascites/rehabilitation , Follow-Up Studies , Humans , Postoperative Complications/classification , Time Factors , Treatment OutcomeABSTRACT
Se realizo un estudio comparativo retrospectivo de 55 pacientes con el diagnóstico de cirrosis hepática entre los años 1990-91, solo 29 pacientes en 2 grupos para el tratamiento de la ascitis, grupo I tratados con diuréticos y grupo 2 tratados con parancetesis evaluadora e infusión intravenosa de Dextran 70 y/o albúmina, se realizo análisis estadístico de la edad, sexo, tipo de complicaciones que se presento en cada grupo, mortalidad, tipo tratamiento realizado y estadía hospitalaria. La paracentesis fue efectiva en eliminar la ascitis y no produjo cambios significativos. En cambio, el tratamiento diurético presento una incidencia significativa de transtornos hidroelectrolíticos, encefalopatía e insuficiencia renal, la duración de la estancia hospitalaria fue significativamente mas corta en los pacientes tratados con paracentesis que en aquellos tratados con diuréticos.
