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Quality of life in refractory ascites: Transjugular intrahepatic portal‐systemic shunting versus medical therapy
Author(s) -
Campbell Mical S.,
Brensinger Colleen M.,
Sanyal Arun J.,
Gennings Chris,
Wong Florence,
Kowdley Kris V.,
McCashland Timothy,
Reddy K. Rajender
Publication year - 2005
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20840
Subject(s) - medicine , ascites , randomization , hepatic encephalopathy , randomized controlled trial , spontaneous bacterial peritonitis , paracentesis , quality of life (healthcare) , refractory (planetary science) , cirrhosis , surgery , gastroenterology , physics , nursing , astrobiology
Uncontrolled studies suggest that transjugular intrahepatic portal‐systemic shunting (TIPS) may improve quality of life in patients with refractory ascites. We hypothesized that any improvement of quality of life in patients with TIPS would be matched in controls due to the competing effects of improved ascites and worsened hepatic encephalopathy. Thus, an analysis of quality of life was performed using original data from the North American Study for the Treatment of Refractory Ascites, a multicenter trial of 109 patients randomized to TIPS or repeated large volume paracentesis (LVP) for refractory ascites. Short form 36 (SF‐36) surveys were completed at baseline and at 6‐ and 12‐month follow‐up. Variables analyzed were: randomization group, number of LVP performed, cumulative volume from LVP, shortness of breath, abdominal distention, abdominal pain, diuretic usage, confusion, hospitalizations, and emergency room visits. Outcomes were changes in physical component scale (PCS) and mental component scale (MCS) of SF‐36 results. We constructed multivariable, mixed effects models, including randomization group and baseline MCS and PCS. Changes in PCS and MCS from baseline were similar between the two randomization groups. In multivariate analysis, PCS improvement was associated with lack of confusion, improved ascites, and lack of hospitalizations, but not directly with randomization group. Improvement in MCS was associated with randomization to TIPS and lack of confusion. In conclusion , patients with refractory ascites randomized to TIPS or repeated LVP had similar changes in quality of life. Competing effects of hepatic encephalopathy, requirement for repeated LVP, and need for hospitalizations explain similar changes in quality of life between the two groups. (H EPATOLOGY 2005.)