COMMENTARY

Management of Ascites

Rowen K. Zetterman, MD

Disclosures

April 05, 2011

In This Article

Prognosis of Ascites

Once ascites develops in patients with end-stage liver disease, the 1- and 5-year survival rates are 85% and 56%, respectively.[2] Sodium retention (<10 mEq/L urinary sodium) worsens the prognosis. Prognosis is even poorer in the presence of renal failure, nutritional deficits, or spontaneous peritonitis. The 1-year mortality for patients with SBP approaches 50%.[24]

Conclusion

The development of ascites in patients with advanced liver disease carries a poor prognosis. Complications of ascites, including increased portal pressure, renal dysfunction, or ascites, add to risks for variceal hemorrhage, azotemia, and death. An approach of controlling ongoing liver injury, dietary sodium restriction, and sequential diuretic use should be instituted as soon as ascites is discovered.

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