Annals of hepatology · 2026
Treatment outcomes in hepatic hydrothorax: A propensity score-matched survival analysis.
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Huang Pei-Ming, Kuo Shuenn-Wen, Liao Hsien-Chi
Аннотация
INTRODUCTION AND OBJECTIVES: This study evaluated the prognostic impact of hepatic hydrothorax (HH) in decompensated cirrhosis and compared outcomes between conservative therapy and surgical diaphragmatic repair.
PATIENTS AND METHODS: This single-center retrospective cohort included 48,464 adults with decompensated cirrhosis from 2004 to 2024. After exclusions, 386 patients (0.8%) were identified with HH, of whom 120 underwent surgical repair and 266 received conservative management. Clinical characteristics and laboratory data were analyzed. The primary endpoint was 365-day mortality. Propensity score matching (1:1, caliper 0.2) incorporating eight clinically relevant variables was used to balance baseline differences. Mortality risk was assessed using generalized estimating equations and Cox proportional hazards models.
RESULTS: Before matching, the conservative group had more severe liver dysfunction, with higher Child-Pugh scores (10.3 ± 3.0 vs. 8.8 ± 2.7, p < 0.001), while MELD scores were lower (16.5 ± 2.4 vs. 26.28 ± 16.17, p < 0.001). The 365-day mortality was 64.3% (171/266) in the conservative therapy group and 51.7% (62/120) in the surgical repair group, corresponding to a crude risk ratio of 1.24 (95% CI, 1.01-1.53) and an odds ratio of 1.69 (95% CI, 1.08-2.65). Survival analysis demonstrated a significant difference between groups (unadjusted log-rank test, χ² = 8.330, p = 0.004). After matching, 119 pairs showed well-balanced baseline characteristics. In the matched cohort, 1-year mortality remained lower with surgery (40.3% vs. 59.7%; Cohen's h = 0.39).
CONCLUSIONS: Surgical diaphragmatic repair was associated with lower 1-year mortality compared with conservative management after adjustment for measured baseline differences.
PATIENTS AND METHODS: This single-center retrospective cohort included 48,464 adults with decompensated cirrhosis from 2004 to 2024. After exclusions, 386 patients (0.8%) were identified with HH, of whom 120 underwent surgical repair and 266 received conservative management. Clinical characteristics and laboratory data were analyzed. The primary endpoint was 365-day mortality. Propensity score matching (1:1, caliper 0.2) incorporating eight clinically relevant variables was used to balance baseline differences. Mortality risk was assessed using generalized estimating equations and Cox proportional hazards models.
RESULTS: Before matching, the conservative group had more severe liver dysfunction, with higher Child-Pugh scores (10.3 ± 3.0 vs. 8.8 ± 2.7, p < 0.001), while MELD scores were lower (16.5 ± 2.4 vs. 26.28 ± 16.17, p < 0.001). The 365-day mortality was 64.3% (171/266) in the conservative therapy group and 51.7% (62/120) in the surgical repair group, corresponding to a crude risk ratio of 1.24 (95% CI, 1.01-1.53) and an odds ratio of 1.69 (95% CI, 1.08-2.65). Survival analysis demonstrated a significant difference between groups (unadjusted log-rank test, χ² = 8.330, p = 0.004). After matching, 119 pairs showed well-balanced baseline characteristics. In the matched cohort, 1-year mortality remained lower with surgery (40.3% vs. 59.7%; Cohen's h = 0.39).
CONCLUSIONS: Surgical diaphragmatic repair was associated with lower 1-year mortality compared with conservative management after adjustment for measured baseline differences.