The CIRrhotic Ascites Severity (CIRAS) model predicts hepatic hydrothorax at all stages of ascites

TY - JOUR

T1 - The CIRrhotic Ascites Severity (CIRAS) model predicts hepatic hydrothorax at all stages of ascites

AU - Gantzel, Rasmus Hvidbjerg

AU - Deleuran, Thomas

AU - Vilstrup, Hendrik

AU - Watson, Hugh

AU - Jepsen, Peter

N1 - Publisher Copyright: © 2024 The Author(s)

PY - 2024/10

Y1 - 2024/10

N2 - Background: Hepatic hydrothorax (HH) is a rare but severe manifestation of cirrhotic ascites. Whether HH development relates to ascites severity is uncertain and simple clinical models to predict HH from all stages of ascites are missing. The recently published CIRrhotic Ascites Severity (CIRAS) model using only ascites-related variables may serve this purpose. Aim: We investigated if the CIRAS model within one year predicts the development of HH requiring thoracentesis in patients with cirrhosis and ascites. Methods: We used data from 1090 patients with cirrhosis and all severities of ascites enrolled in three randomized clinical trials with available CIRAS model scores and no history of HH. Fine and Gray regression was applied to estimate the CIRAS model's ability to predict HH. Results: Thirty-five patients developed HH requiring thoracentesis. The CIRAS model stratified patients at different risks for HH and increasing CIRAS score was associated with a higher risk for HH (sHR 1.49 [95% CI: 1.19–1.86]). The CIRAS model's discriminatory ability achieved an AUC of 0.67 (95% CI: 0.56–0.77); higher than of the cirrhosis severity scores Child-Pugh and MELD variants. Conclusion: The CIRAS model predicts the development of HH in cirrhosis patients with any grade of ascites, suggesting a potential for improved pre-emptive HH management. This complements the general movement towards personalised treatments and care.

AB - Background: Hepatic hydrothorax (HH) is a rare but severe manifestation of cirrhotic ascites. Whether HH development relates to ascites severity is uncertain and simple clinical models to predict HH from all stages of ascites are missing. The recently published CIRrhotic Ascites Severity (CIRAS) model using only ascites-related variables may serve this purpose. Aim: We investigated if the CIRAS model within one year predicts the development of HH requiring thoracentesis in patients with cirrhosis and ascites. Methods: We used data from 1090 patients with cirrhosis and all severities of ascites enrolled in three randomized clinical trials with available CIRAS model scores and no history of HH. Fine and Gray regression was applied to estimate the CIRAS model's ability to predict HH. Results: Thirty-five patients developed HH requiring thoracentesis. The CIRAS model stratified patients at different risks for HH and increasing CIRAS score was associated with a higher risk for HH (sHR 1.49 [95% CI: 1.19–1.86]). The CIRAS model's discriminatory ability achieved an AUC of 0.67 (95% CI: 0.56–0.77); higher than of the cirrhosis severity scores Child-Pugh and MELD variants. Conclusion: The CIRAS model predicts the development of HH in cirrhosis patients with any grade of ascites, suggesting a potential for improved pre-emptive HH management. This complements the general movement towards personalised treatments and care.

KW - Ascites severity

KW - Patient-reported outcome

KW - Prediction model

KW - Thoracentesis

UR - http://www.scopus.com/inward/record.url?scp=85202175110&partnerID=8YFLogxK

U2 - 10.1016/j.clinre.2024.102452

DO - 10.1016/j.clinre.2024.102452

M3 - Journal article

C2 - 39179203

AN - SCOPUS:85202175110

SN - 2210-7401

VL - 48

JO - Clinics and Research in Hepatology and Gastroenterology

JF - Clinics and Research in Hepatology and Gastroenterology

IS - 8

M1 - 102452

ER -