Prevalence of Hepatic Hydrothorax in Patients with Chronic Liver Disease Presenting in Tertiary Center of Nepal.

Background Hepatic hydrothorax is a common cause of pleural effusion in chronic liver disease. It is associated with poor outcome of the disease. Objective To study the prevalence of hepatic hydrothorax in patient with chronic liver disease. Method A hospital based prospective observational study conducted from July 15, 2022 to July 15, 2023. Diagnostic thoracentesis was performed to the patients presenting with pleural effusion at the time of admission. Chest x-ray was repeated at day 7 to assess the outcome of the appropriate treatment. Result Out of 752 enrolled participants, 105 were diagnosed with pleural effusion. The predominant cause was hepatic hydrothorax (80%), followed by tuberculosis (13.3%). 26.2% experienced spontaneous bacterial empyema. Most of the patients (74%) were classified as Child-Pugh C score. The prevalence of hepatic hydrothorax was 11.17%. Among 84 patients with hepatic hydrothorax, the mean age was 49.42±11.93 years, with a male predominance (male to female ratio, 68:32). Hepatic hydrothorax primarily occurred on the right side (78.6%), followed by left (15.5%) and bilaterally (6%). Mild hepatic hydrothorax was most common (48.8%), followed by moderate (31%) and massive (20.2%). About 65.5% were improved with treatment, while the mortality rate was 34.52%. Renal causes were the most common cause of death, accounting for 58.62% of mortalities. Conclusion Hepatic hydrothorax was prevalent in 11.17% of patients. It predominantly occurred on right side, with advanced Child Pugh score and often associated with spontaneous bacterial empyema (26.2%). The condition carried a mortality rate of 34.52%, with renal causes accounting for the majority of deaths (58.62%). All pleural effusions in chronic liver disease should undergo prompt evaluation because it is often associated with various complications and carries high mortality rate.