Prognostic factors for peritoneovenous shunt placement for refractory ascites in liver cirrhosis

Table 1 Indications for peritoneovenous shunt placement

Indication for PVS placement
Ascites refractory to medical treatment
Multiple CART or multiple abdominal paracenteses performed
Contraindication
Presence of bacterial peritonitis
Positive findings of endotoxin and bacteria in ascitic fluid
White blood cell counts in ascitic fluid of 500/μL or higher
Patients requiring caution
Patients with concurrent heart failure or pulmonary edema
Patients with significantly impaired liver function (Child-Pugh score of 14 or higher)
Patients with severe renal dysfunction
PS 2 or higher

PVS: Peritoneovenous shunt; CART: Concentrated ascites reinfusion therapy; PS: Performance status.

Table 2 Patient summary, mean ± SD

Characteristic	Finding
Age	65.5 ± 10.1
Female/male	69/31
Etiology of HBV/HCV/alcohol/MASLD/others	41/7/32/9/11
Child-Pugh classification of A/B/C	0/59/41
Child-Pugh score	9.41 ± 1.46
ALBI score	-1.19 ± 0.53
Platelet as 103/μL	109 ± 52.7
Operation time in minutes	83.5 ± 23.7
Morbidity, +/-	15/85
Post operative hospital stay in days	24.6 ± 28.4
Liver volume in mL	1024 ± 324
Spleen volume in mL	344 ± 182

HBV: Hepatitis B virus; HCV: Hepatitis C virus; MASLD: Metabolic dysfunction-associated steatotic liver disease; ALBI: Albumin-bilirubin.

Table 3 Comparison of the S-group and L-group, mean ± SD

Variable	S-group1, n = 43	L-group2, n = 57	P value
Age	69.3 ± 9.11	62.6 ± 10.1	0.001
Female/male	26/17	43/14	0.083
Child-Pugh classification A/B/C	0/18/25	0/41/16	0.004
Child-Pugh score	10.1 ± 1.65	8.93 ± 1.10	0.001
ALBI score	-1.30 ± 0.45	-1.58 ± 0.55	0.009
Platelet as 103/μL	117 ± 63.2	133 ± 64.3	0.231
Operation time in minute	86.1 ± 32.2	81.8 ± 16.2	0.472
Morbidity	9	6	0.243
Post operative hospital stay in days	28.1 ± 28.4	24.3 ± 29.0	0.575
Liver volume in mL	897 ± 211	1129 ± 368	0.004
Spleen volume in mL	396 ± 207	378 ± 262	0.773

¹L-group, patients who survived more than 180 days after peritoneovenous shunt placement.

²S-group, patients who survived for less than 180 days after peritoneovenous shunt placement.

ALBI: Albumin-bilirubin.

Table 4 Peritoneovenous shunt grade

Variable	Point assigned
Parameter	0	1
Age	≤ 60	> 60
Sex	Male	Female
Child-Pugh score	5-9	10-15
Liver volume in mL	> 1057	≤ 1057
Grade
A	0-2
B	3-4

Table 5 Multivariate analysis

Variable	Hazard ratio	95%CI	P value
Age	1.047	1.005-1.090	0.027
Sex	0.374	0.165-0.866	0.022
Child-Pugh score	1.286	1.016-1.626	0.036
Liver volume	1.001	0.999-1.002	0.264
PVS grade	0.292	0.103-0.828	0.021

CI: Confidence interval; PVS: Peritoneovenous shunt.