Analysis of clinical features and prognostic factors associated with Hepatic Hydrothorax: A single center study from China

Background: The clinical features and factors affecting prognostic survival of Hepatic Hydrothorax (HH) are currently unknown. Aims: We aimed to analyze the clinical characteristics and prognostic factors associated with patients with HH. Methods: We conducted a retrospective cohort study of 131 patients with HH, using the Kaplan-Meier method and Cox proportional risk regression analysis to assess factors influencing the prognosis of HH. Results: A total of 131 patients were collected, male: female 80:51 (1.59:1), mean age 52.76±11.88 years, 30 survived and 101 died. Hepatitis B cirrhosis was the main cause of HH, accounting for 42% of cases. Abdominal distention and dyspnea were the most common clinical signs, present in 82.4% and 67.9% of patients, respectively. Ascites was present in varying amounts in all patients and was the most common decompensated complication, with pleural effusions mostly seen on the right side (107/131; 82%), followed by the left side (16/131; 12%) and bilateral effusions (8/131; 6%); 20 (15%) were treated with drug management alone, 111 (75%) patients were treated with drugs and thoracic intubation, with one patient treated with TIPS and three patients treated with liver transplantation at a later stage of treatment. Mortality rates were significantly higher in men than in women at all time points, with an overall 2-year mortality rate of 70.3% and a 5-year mortality rate of 100%. Univariate Cox proportional risk models indicating that gender, liver failure, hepatic encephalopathy, hyponatraemia, total bilirubin (TBIL), MELD score, and MELD-Na score were associated with survival ( P < 0.05), and multifactorial Cox proportional risk models indicating that hepatic encephalopathy, hyponatraemia, and MELD score ( P < 0.05) were independent risk factors for prognostic survival in patients with HH. Patients with HH had a worse prognosis with higher MELD scores and an even worse prognosis once combined with hyponatraemia, with a mean survival time difference of nearly two times. Conclusion: HH patients have a high mortality rate, and liver encephalopathy, hyponatremia, and the MELD score are significantly associated with their condition and prognosis.