Intra-Abdominal Hypertension and Its Prognostic Impact on Mortality in Cirrhotic Patients with Ascites: The Role of Paracentesis.

Background/aims: Elevated intra-abdominal pressure (IAP) can lead to intra-abdominal hypertension (IAH) and, in severe cases, abdominal compartment syndrome (ACS) in patients with cirrhosis and ascites. Paracentesis reduces IAP and improves abdominal perfusion. Intra-abdominal hypertension can also trigger acute-on-chronic liver failure (ACLF) in decompensated cirrhosis. This study evaluates the association between IAH and short-term mortality in patients with cirrhosis and ascites.

Materials and methods: This prospective, single-center cohort study included 18 patients (7 females, 11 males; median age: 59) scheduled for therapeutic paracentesis. Intra-abdominal pressure was measured using the bladder technique. Patients were grouped based on initial Chronic Liver Failure Consortium Organ Failure (CLIF-C OF) scores as ACLF or non-ACLF and followed up for 3 months.

Results: The median model for end-stage liver disease score was 17 (IQR 11-19). The primary etiologies of cirrhosis were viral hepatitis and alcoholic liver disease. Independent risk factors for IAH included advanced liver disease and large-volume ascites. Pre-paracentesis IAP was higher in ACLF patients (22 vs. 18 mm Hg). Post-paracentesis IAP was also higher in ACLF patients (14 vs. 8 mm Hg, P = .007). The 3-month mortality rate was 50%, with worse survival in ACLF patients (24 vs. 76.9 days, P = .002). Pre-paracentesis IAP was significantly higher in patients who died (22 vs. 18 mm Hg, P = .034), and survival was worse in those with IAP ≥18.5 mm Hg (P = .026).

Conclusion: Intra-abdominal pressure is elevated in cirrhosis patients with grade 3 ascites. Despite similar paracentesis volumes, IAP remained higher in the ACLF group. Intra-abdominal pressure ≥18.5 mm Hg is associated with significantly reduced survival, indicating that IAH accelerates short-term mortality in these patients.