Indwelling Pleural Catheter as a Safe and Convenient Alternative to Serial Thoracentesis for the Management of Hepatic Hydrothorax

BACKGROUND: Serial thoracentesis is an established management strategy for hepatic hydrothorax (HH) patients who are intolerant to diuretics or not candidates for transjugular intrahepatic portosystemic shunt (TIPS) placement, but it carries a risk of complications. The role of indwelling pleural catheters (IPCs) in HH management remains controversial. This study aims to evaluate the safety and efficacy of IPCs compared with serial thoracentesis in patients with HH. METHODS: We conducted a retrospective, propensity-matched cohort study using US population-based data, aged 18 to 89 years with HH secondary to cirrhosis of any etiology. Exclusion criteria included malignancy, congestive heart failure, nephrotic syndrome, chronic kidney disease, TIPS placement, or pleural effusions due to causes other than hepatic hydrothorax. Patients were stratified into 2 cohorts: (1) HH managed with IPCs placement and (2) HH managed with serial thoracentesis. After 1:1 propensity score matching, multivariate regression analysis was performed to evaluate primary and secondary outcomes over 18 months following the index intervention. RESULTS: All-cause mortality at 18 months was comparable between the IPCs and serial thoracentesis cohorts (odds ratio [OR]: 0.662, 95% CI: 0.434-1.108). However, patients in the serial thoracentesis group demonstrated higher odds of emergency room visits (OR: 2.273, 95% CI: 1.423-3.631), urgent care visits (OR: 1.581, 95% CI: 1.464-2.531), hepatic encephalopathy (OR: 2.351, 95% CI: 1.354-4.084), pneumonia (OR: 1.889, 95% CI: 1.075-3.320), liver transplantation (OR: 2.744, 95% CI: 1.276-5.897), and hypokalemia (OR: 2.028, 95% CI: 1.136-3.619) compared with the IPCs cohort. CONCLUSION: IPCs placement was associated with a lower risk of emergency room and urgent care visits, hepatic encephalopathy, pneumonia, hypokalemia, and reduced need for liver transplantation compared with serial thoracentesis in patients with HH.