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Quality of life in refractory ascites after treatments

Patients with refractory ascites receiving either TIPS or repeated large volume paracentesis have similar changes in quality of life, explained by factors such as competing effects of hepatic encephalopathy, reports September's Hepatology.

News image

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Uncontrolled studies suggest that transjugular intrahepatic portal-systemic shunting (TIPS) may improve quality of life in patients with refractory ascites.

Dr Rajender Reddy and colleagues considered that any improvement of quality of life in patients with TIPS would be matched in controls.

The investigators hypothesized that these improvements would be due to the competing effects of improved ascites and worsened hepatic encephalopathy.

The investigative team performed an analysis of quality of life using original data from the North American Study for the Treatment of Refractory Ascites.

This study is a multicenter trial of 109 patients randomized to TIPS or repeated large volume paracentesis for refractory ascites.

Short form 36 (SF-36) surveys were completed at baseline and at 6- and 12-month follow-up.

The investigators analyzed variables such as randomization group, and number of large volume paracentesis performed.

SF-36 physical component scale improvements were associated with lack of hospitalizations
Hepatology

Cumulative volume from large volume paracentesis, and shortness of breath were also assessed.

Other variables assessed by the team included abdominal distention, abdominal pain, diuretic usage, confusion, hospitalizations, and emergency room visits.

The team's outcomes included the physical component scale and mental component scale of SF-36 survey results.

The investigators constructed multivariable, mixed effects models, including randomization group and baseline mental and physical component scales.

The investigative team found that changes in the mental and physical component scales from baseline were similar between the 2 randomization groups.

In multivariate analysis, improvement in the physical component scale was associated with lack of confusion, improved ascites, and lack of hospitalizations.

The team noted that improvements in the physical component scale were not directly associated with randomization group.

The investigators found that improvement in the mental component scale was associated with randomization to TIPS, and lack of confusion.

Dr Reddy's team commented, “Patients with refractory ascites randomized to TIPS or repeated large volume paracentesis had similar changes in quality of life.”

“Competing effects of hepatic encephalopathy, requirement for repeated large volume paracentesis, and need for hospitalizations explain similar changes in quality of life between the 2 groups.”

Hepatol 2005: 42(3): 635-40
24 August 2005

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