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

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.