S2330 Indwelling Pleural Catheter as a Safe and Convenient Alternative to Serial Thoracentesis for the Management of Hepatic Hydrothorax: A Retrospective Propensity-Matched Cohort Study

Introduction: 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), such as the PleurX catheter, in HH management remains controversial. This study aims to evaluate the safety and efficacy of PleurX catheters compared to serial thoracentesis in patients with HH. Methods: We conducted a retrospective, propensity-matched cohort study using U.S. population-based data, aged 18–89 years with HH secondary to cirrhosis of any etiology. Exclusion criteria included malignancy, congestive heart failure, nephrotic syndrome, chronic kidney disease, transjugular intrahepatic portosystemic shunt placement, or pleural effusions due to causes other than hepatic hydrothorax. Patients were stratified into 2 cohorts: (1) HH managed with PleurX catheter 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 PleurX and serial thoracentesis cohorts (odds ratio [OR] 0.662, 95% confidence interval [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 to the PleurX cohort. Conclusion: To the best of our knowledge, this is the largest US population-based study directly comparing the impact of PleurX catheters versus serial thoracentesis in patients with pleural effusions secondary to liver cirrhosis. Our data concluded that PleurX catheter 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 to serial thoracentesis in patients with HH. Careful patient selection and close monitoring remain critical for optimizing outcomes in patients undergoing indwelling pleural catheter placement.