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Risk Factors for Hepatic Hydrothorax in Cirrhosis Patients with Ascites – A Clinical Cohort Study

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The risk factors for hepatic hydrothorax are unknown.


We used data from three randomized trials of satavaptan treatment in patients with cirrhosis and ascites followed for up to 1 year. We excluded patients with previous hepatic hydrothorax or other causes for pleural effusion. The candidate risk factors were age, sex, heart rate, mean arterial pressure, diuretic-resistant ascites, a recurrent need for paracentesis, diabetes, hepatic encephalopathy, International Normalized Ratio, creatinine, bilirubin, albumin, sodium, platelet count, use of non-selective beta-blockers (NSBBs), spironolactone, furosemide, proton pump inhibitors, and insulin. We identified risk factors using a Fine and Gray regression model and backward selection. We reported subdistribution hazard ratios (sHR) for hepatic hydrothorax. Death without hepatic hydrothorax was a competing risk.


Our study included 942 patients, of whom 41 developed hepatic hydrothorax and 65 died without having developed it. A recurrent need for paracentesis (sHR: 2.55, 95% CI: 1.28–5.08), bilirubin (sHR: 1.18 per 10 µmol/l increase, 95% CI: 1.09–1.28), diabetes (sHR: 2.49, 95% CI: 1.30–4.77) and non-use of non-selective beta-blockers (sHR: 2.27, 95% CI: 1.13–4.53) were risk factors for hepatic hydrothorax. Development of hepatic hydrothorax was associated with a high mortality-hazard ratio of 4.35 (95% CI: 2.76–6.97).


In patients with cirrhosis and ascites, risk factors for hepatic hydrothorax were a recurrent need for paracentesis, a high bilirubin, diabetes and non-use of NSBBs. Among these patients with cirrhosis and ascites, development of hepatic hydrothorax increased mortality fourfold.

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The authors thank Sanofi-Aventis R&D for providing access to the complete trial database from the satavaptan phase III trials in cirrhotic ascites and for permission to perform the analyses included in this publication.


This post-hoc analysis of the satavaptan trial data received no specific funding.

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Correspondence to Thomas Deleuran.

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Hugh Watson holds shares in Sanofi. No other disclosures.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Deleuran, T., Watson, H., Vilstrup, H. et al. Risk Factors for Hepatic Hydrothorax in Cirrhosis Patients with Ascites – A Clinical Cohort Study. Dig Dis Sci 67, 3395–3401 (2022).

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