Increased Risk of ACLF and Inpatient Mortality in Hospitalized Patients with Cirrhosis and Hepatic Hydrothorax

Jacqueline G. O’Leary, K. Rajender Reddy, Puneeta Tandon, Scott W. Biggins, Florence Wong, Patrick S. Kamath, Guadalupe Garcia-Tsao, Benedict Maliakkal, Jennifer C. Lai, Michael Fallon, Hugo E. Vargas, Paul Thuluvath, Ram Subramanian, Leroy R. Thacker, Jasmohan S. Bajaj

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: Hepatic hydrothorax (HH) remains a difficult-to-treat complication of cirrhosis. Aim: To define the mortality, length of stay (LOS), and risk of ACLF in patients admitted with HH. Methods: We utilized the North American Consortium for the Study of End-stage Liver Disease, a prospective cohort of 2868 non-electively hospitalized patients with cirrhosis from 14 tertiary care hepatology centers in North America. A total of 121 patients who required an inpatient thoracentesis (HH group) were compared to 736 patients with refractory ascites without HH, and to 1639 patients without these complications (Other). Patients with a TIPS before or during admission were excluded. Results: There were no differences between the groups in age, gender, or liver disease etiology. Admission MELD (20.5, 21.6 vs. 18.7; p < 0.0001) was lower in HH than RA patients but lowest in other patients, respectively. In hospital, HH patients’ rate of second infections and ICU transfer were the highest, and their LOS was the longest of all groups. Despite a similar mean discharge MELD compared to RA patients, the 90-day transplant rate was lower. Multivariable modeling showed patients with HH had an increased risk of ACLF (HR = 2.37 vs. RA, HR = 2.56 vs. Other; p = 0.01) even when controlling for MELD score, AKI, second infection, and history of prior 6-month hospitalization. Multivariable modeling also showed that HH increased the risk of inpatient mortality (HR = 2.22 vs. RA alone, HR = 2.31 vs. Other; p = 0.04). Conclusions: HH that required a therapeutic thoracentesis more than doubled the risk of ACLF and inpatient mortality among hospitalized patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)3612-3618
Number of pages7
JournalDigestive diseases and sciences
Issue number10
StatePublished - Oct 2021


  • ACLF
  • Cirrhosis
  • Decompensation
  • Liver transplant

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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