#48 - Hepatic Hydrothorax Versus Refractory Ascites: Comparative Survival and Outcome Predictors in Decompensated Cirrhosis

Introduction and Objectives Hepatic hydrothorax (HH) is a complication of advanced chronic liver disease (CLD) whose prognostic impact, compared to other severe portal hypertension-related decompensations, remains poorly defined. The objective was to compare transplant-free survival between patients with HH and refractory ascites (RA) and to identify predictors of outcome. Materials and Methods Retrospective study of patients with CLD decompensated by HH or RA. Baseline clinical and biochemical characteristics, MELD-Na at diagnosis, follow-up at 1 month and 90 days, complications, and transplant-free survival as a composite endpoint were analyzed. Statistical analysis included Kaplan-Meier curves, log-rank test, and Cox regression. Results 49 patients (55% female, median age 54 years, IQR 47-61): HH without ascites n=6, HH with ascites n=28, RA n=15. Groups were comparable at baseline for MELD-Na (16.2, 16.9, and 19.2, p=0.617) and renal function. 23 events occurred (20 deaths, 3 transplants). Median survival was shorter in HH (141 and 184 days) than in RA (541 days, log-rank p=0.22). 90-day survival was 83%, 64%, and 100%, respectively ( Figure 1). On multivariable analysis (concordance=0.78), bilirubin was an independent predictor of outcome (HR=1.20, 95%CI 1.03-1.40, p=0.021). In the HH subgroup, non-selective beta-blocker use showed a trend toward lower event risk (HR=0.36, 95%CI 0.13-1.03, p=0.057). Conclusions HH was associated with substantially shorter survival than RA despite comparable baseline MELD-Na, raising questions about whether current prognostic tools adequately capture its severity. Bilirubin was an independent outcome predictor, and beta-blocker use showed an exploratory signal of potential benefit in HH.