Abstract
Background
Treatment options for refractory ascites (RA) in cirrhosis are scarce. When TIPS insertion is contraindicated, tunneled peritoneal catheters (cPeCa) offer an alternative treatment. However, cPeCa are associated with high incidences of infection-related complications. Novel PeCa embedded with silver particles (sPeCa) have been introduced to address this issue.
Methods
We evaluated all patients with cirrhosis and RA treated with PeCa or ascites pump at Hannover Medical School from 2012–2023. Analysis was conducted utilizing a multivariable Competing-Risk-Analysis and afterwards a 3:1-Propensity-Score-Matching (PSM) to adjust for potential differences. Last, sPeCa-patients were compared to those with ascites pump. Study endpoints were mortality, peritonitis, device explantation and rehospitalization.
Results
150 patients with cPeCa were compared to 27 sPeCa-patients. Treatment with sPeCa was associated with significantly reduced incidences of peritonitis (HR 0.28, p = 0.002), device explantation (HR 0.37, p = 0.03) and rehospitalization (HR 0.48, p = 0.02). After PSM, 81 cPeCa-patients were compared to 27 sPeCa-patients. Mortality was comparable (HR 1.66, p = 0.29). Patients with sPeCa experienced less peritonitis (HR 0.34, p = 0.008), explantation (HR 0.39, p = 0.04) and rehospitalization (HR 0.52, p = 0.046). When compared to ascites-pump, sPeCa-patients demonstrated similar rates of mortality (HR 0.95, p = 0.94), peritonitis (HR 0.97, p = 0.96) and explantation (HR 0.89, p = 0.88), while rehospitalization rate was significantly higher in ascites pump (HR 2.83, p = 0.02).
Conclusion
Treatment with sPeCa is associated with less infection-associated complications and could therefore be a superior therapeutic approach compared to cPeCa.