Palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

Table 1 Comparison of baseline characteristics of cirrhotic patients with refractory ascites palliated with long-term abdominal drain or repeat large volume paracentesis, n (%)

Baseline characteristics	LTAD (n = 30)	LVP (n = 19)	P value
Age, yr (SD)	71 (11)	66 (12)	0.07
Male sex	18 (60)	15 (79)	0.22
Child-Pugh score (IQR)	9 (2)	9 (2)	0.48
Child-Pugh class B/C	24/11 (69/31)	12/7 (63/37)	0.76
Aetiology (MASLD/ArLD/Viral/Other)	9/12/2/7 (30/40/7/23)	3/10/1/5 (16/53/5/26)	0.69
HCC	5 (17)	4 (21)	0.46
Proteins in ascites ≤ 15 g/L	14 (47)	9 (47)	0.76
Prophylactic antibiotics	25/311 (81)	8/19 (42)	0.012
Previous peritonitis	2 (7)	5 (26)	0.86
T2DM	12 (40)	8 (42)	1.00
Use of metformin	3 (10)	3 (16)	0.66
Use of diuretics	18 (60)	12 (63)	1.00
Use of NSBBs	13 (43)	4 (21)	0.13
Use of antihypertensive	2 (7)	2 (10)	0.66
Use of lactulose	13 (43)	13 (68)	0.14
Baseline creatinine (IQR)	104 (68)	84 (143)	0.44

¹Data on prophylactic antibiotics were available for 31/35 long-term abdominal drains.

LTAD: Long-term abdominal drain; LVP: Large volume paracentesis; SD: Standard deviation; IQR: Interquartile range; MASLD: Metabolic dysfunction-associated steatotic liver disease; ArLD: Alcohol-related liver disease; HCC: Hepatocellular carcinoma; T2DM: Type 2 diabetes mellitus; NSBBs: Non-selective beta-blockers; AKI: Acute kidney injury.

Table 2 Comparative outcomes and safety events by type of ascitic drainage, n (%)

Outcomes	LTAD (n = 30)	LVP (n = 19)	P value
Median survival, d	124 (330)	297 (438)	0.06
Median follow-up (with drain in place/undergoing LVP), d	135 (226)	80 (239)	0.98
Ascites/drain related admissions	11 (37)	17 (89)	0.004
Time to first hospitalisation, (IQR), d	44 (93)	10 (35)	0.002
AKI	8 (27)	11 (58)	0.014
Drain-related complications	14 (47)	11 (58)	0.06
Patients with peritonitis	5 (17)	5 (26)	0.46
Total No. of peritonitis episodes	10 (33)	5 (26)	0.98
Cellulitis	4 (13)	2 (10)	1.00
Site leakage	12 (40)	2 (10)	0.10
Bleeding of drain site	2 (7)	1 (5)	1.00
Hypotension	6 (20)	4 (21)	0.71

LTAD: Long-term abdominal drain; LVP: Large volume paracentesis; AKI: Acute kidney injury.