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Incidence of, Risk Factors for, and Outcomes After Ascites in a Population-Based Cohort of Older Americans

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Abstract

Background

The incidence of, risk factors for, and outcomes after the development of ascites are poorly described for contemporary patients with cirrhosis.

Methods

We examined data for a 20% random sample of US Medicare enrollees with cirrhosis and Part D prescription coverage from 2008 to 2019, excluding patients with heart failure and diuretic use prior to cirrhosis. Among 63,364 persons with cirrhosis, we evaluated the incidence of ascites using an Aalen–Johansen estimator. We evaluated risk factors for ascites, mortality, and mortality after ascites using multistate modeling. We determined the associations with each outcome for an array of medication exposures including nonselective beta-blockers, antiviral therapy, statins, rifaximin, anticoagulants, and metformin.

Results

The cumulative incidence of ascites was 5.1%, 9.5%, and 10.7% and 1, 3, and 5 years overall. The corresponding data for ascites requiring paracentesis were 1%, 2.1%, and 2.4%. Persons aged < 65 years, with alcohol-related cirrhosis, varices, or HE, are most likely to develop ascites. The risk of ascites was higher for persons taking any NSBB (including carvedilol) but lower for those taking atorvastatin (but not other statins) and antiviral therapy for Hepatitis C. Incident ascites was associated with increased risk of death, HR 27.6 95%CI(21.7–35.1). Survival following ascites was 1.08 years (interquartile range, IQR, 0.26–2.75), 0.38 years (IQR0.1–1.3) for those requiring paracentesis. Lipophilic statins were the only medications associated with lower mortality after ascites requiring paracentesis.

Conclusions

Ascites is associated with a high risk of death. Very few candidate therapies are associated with the reduction in the risk of ascites and mortality after ascites development.

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Funding

Elliot Tapper receives funding from the National Institutes of Health through NIDDK K23-DK117055. This work was supported in part by an unrestricted research grant from Valeant Pharmaceuticals (makers of Rifaximin). Valeant had no access to the data and played no role in the analysis.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Michigan, 3912 Taubman, SPC 5362, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA

    Elliot B. Tapper, Zhe Zhao, Nik Mazumder & Neehar D. Parikh

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  1. Elliot B. Tapper
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  2. Zhe Zhao
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  4. Neehar D. Parikh
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Contributions

Elliot Tapper is the guarantor of this article. Roles: Concept: Tapper, Analysis: Tapper, Zhe, Mazumder, Parikh, Data acquisition: Tapper, Zhe, Writing: Tapper, Revision: Zhe, Mazumder, Parikh.

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Correspondence to Elliot B. Tapper.

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Tapper, E.B., Zhao, Z., Mazumder, N. et al. Incidence of, Risk Factors for, and Outcomes After Ascites in a Population-Based Cohort of Older Americans. Dig Dis Sci 67, 5327–5335 (2022). https://doi.org/10.1007/s10620-022-07454-3

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  • DOI: https://doi.org/10.1007/s10620-022-07454-3

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