Episode 348: 247. Early diagnostic paracentesis improves outcomes of hospitalized patients with cirrhosis and ascites

Beran A et al. Early diagnostic paracentesis improves outcomes of hospitalized patients with cirrhosis and ascites: A systematic review and meta-analysis. Am J Gastroenterol 2024 Nov; 119:2259. (https://doi.org/10.14309/ajg.0000000000002906)

BOTTOM LINE (if you don’t like to read)- While it might not be fun to have the conversation with the ER provider saying you NEED A DIAGNOSTIC PARACENTESIS PRIOR TO THE PATIENT COMING TO THE FLOOR, just remember that every 33 times we have that conversation, we are saving a life and decreasing the length of stay by 5 days on average.

We have all had the admission from the ER on a patient that needs a paracentesis but it is the weekend so they are going to just admit for antibiotics and then IR can come do it on Monday.

Guidelines recommend diagnostic paracentesis in all patients hospitalized with cirrhosis and ascites, but they do not recommend specific timing of inpatient paracentesis. (Biggins SW et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2021 Aug; 74:1014.

BUT NOW we have a meta-analysis of 7 observational studies (>78,000 patients), patients who underwent diagnostic paracentesis within 12 to 24 hours after admission had significantly better outcomes compared with patients who had more-delayed or no paracentesis!

Those that underwent diagnostic paracentesis within 12 to 24 hours after admission had significantly lower rates of acute kidney injury (24% vs. 35%. NNT 9). They had shorter hospital LOS (5 fewer days!), and lower in-hospital mortality (7% vs 10% NNT 33).

When you looked at the subgroup of patients that underwent paracentesis within 12 hours of admission —in-hospital mortality also was significantly lower with paracentesis within 12 hours versus later paracentesis (12% vs. 26% NNT 7).