Paracentesis outcomes from a medicine procedure service at a tertiary care transplant center

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2025-03-27 DOI:10.1002/jhm.70037

Pete Meliagros MD, MS, Benjamin Chopski DO, Matthew Ambrosio MS, Stanley Liu MD, Somaya Albhaisi MBBCh, MPH, Lana Petrova BS, Evan Ritter MD, Adam Garber MD, FACP, SFHM

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引用次数: 0

Abstract

Background

Paracentesis is a commonly performed procedure with overall low complication rates. There is a paucity of modern data investigating outcomes for inpatients using standardized point of care ultrasound.

Objectives

We aimed to evaluate complication rates and outcomes of paracentesis in patients in the inpatient setting of a large tertiary transplantation center.

Methods

We identified patients with ascites of multiple etiologies undergoing paracentesis by a medicine procedure service at a university center. Univariate and multivariate analyses were conducted to identify clinical and demographic factors associated with kidney injury (AKI) or significant HGB drop (≥2 g/dL).

Results

Of 1746 patients, 12% of patients receiving small volume (≤5 L) and 10% receiving large volume paracentesis (>5 L) developed a post procedural AKI (OR 0.857, 95% CI: 0.633–1.154) with no significant difference between groups (p = .30). In multivariable analysis, Model for End-Stage Liver Disease Sodium (MELD-Na) score as a continuous variable had a more significant impact in the development of AKI (OR 1.15 CI 1.08–1.22, p < .001) as well as patients who were noted to be receiving paracentesis due to clinical deterioration (OR 2.48 CI 1.08–5.7, p < .03). Of 2034 patients, 94% of patients had no significant drop in hemoglobin (<2 g/dL). There was no significant difference in BMI (12.73 vs. 16.68, p = .6), INR (1.6 vs. 1.6, p = .8), or platelet count (114 vs. 106, p > .9) between groups.

Conclusion

Regardless of volume of ascites removed, paracentesis is associated with a low risk of AKI, however there was an increased risk in the clinically decompensating patient. The bleeding risk was also found to be low when performed by experienced proceduralists on a procedure service.

Abstract Image

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一家三级医疗移植中心的药物手术服务的腹腔穿刺结果。

背景：穿刺术是一种常见的手术，总体并发症发生率低。有一个缺乏现代数据调查结果的住院病人使用标准化的护理点超声。目的：我们的目的是评估在一个大型三级移植中心住院患者中穿刺术的并发症发生率和结果。方法：我们在一所大学中心的医学程序服务部门确定了多种病因的腹水患者。进行单因素和多因素分析，以确定与肾损伤（AKI）或显著HGB下降（≥2 g/dL）相关的临床和人口统计学因素。结果：1746例患者中，12%接受小容量（≤5 L）穿刺的患者和10%接受大容量穿刺（>5 L）的患者发生术后AKI (OR 0.857, 95% CI: 0.633-1.154)，组间差异无统计学意义（p = 0.30）。在多变量分析中，终末期肝病模型钠（MELD-Na）评分作为一个连续变量对组间AKI的发展有更显著的影响（OR 1.15 CI 1.08-1.22, p .9）。结论：无论移除腹水的体积大小，穿刺与AKI的低风险相关，但临床失代偿患者的风险增加。当由经验丰富的程序医生进行手术服务时，出血风险也很低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.