S2665 Impact of Transjugular Intrahepatic Portosystemic Shunt (TIPS) vs Repeated Thoracocentesis on Clinical Outcomes in Patients With Hepatic Hydrothorax: A Retrospective Propensity-Matched Cohort Study

Introduction: Hepatic hydrothorax (HH) is a debilitating complication of advanced liver cirrhosis, often necessitating invasive interventions due to resistance to conventional medical therapies. While transjugular intrahepatic portosystemic shunt (TIPS) has established efficacy in managing HH, repeated thoracentesis is more commonly used. This is largely due to lack of comparative safety and efficacy data on infection risk, impact on renal function, and hepatic encephalopathy. Our study aims to evaluate the impact of TIPS versus repeated thoracocentesis on these outcomes in patients with HH. Methods: We conducted a retrospective 1:1 propensity-matched cohort study using U.S. population based data from the TRINETX network including patients aged ≥18 years with HH and liver cirrhosis of any etiology. We excluded patients with CHF, nephrotic syndrome, CKD and pleural effusion due to other causes. Patients were divided into 2 cohorts: HH treated with TIPS, and HH treated with repeated thoracentesis (defined as ≥4 thoracenteses in 2 months). Multivariate regression analysis was employed to assess primary outcomes, including dehydration, sepsis, severe sepsis, septic shock, hepatic encephalopathy, acute kidney injury (AKI), hyponatremia, pneumothorax, and empyema within 3 months. Secondary outcomes like liver transplantation (LT) and spontaneous bacterial peritonitis (SBP) were also analyzed. 1:1 propensity matching was performed on variables such as demographics, use of medications (diuretics) and laboratory parameters to reduce confounding. Odds ratios and 95% CI were reported. Results: Propensity matched cohort analysis showed that patients treated with TIPS had a significantly lower incidence of developing sepsis (OR 0.473, 95% CI: 0.314–0.711), AKI (OR 0.515, 95% CI: 0.356–0.745), hyponatremia (OR 0.413, 95% CI: 0.194–0.880), pneumothorax (OR 0.257, 95% CI: 0.151–0.438), empyema (OR 0.293, 95% CI: 0.142–0.604), SBP (OR 0.497, 95% CI: 0.282–0.862), and need for LT (OR 0.374, 95% CI: 0.242–0.576) than those treated with repeated thoracentesis. However TIPS-treated patients had a significantly higher risk of hepatic encephalopathy (OR 2.031, 95% CI: 1.368–3.016). Conclusion: TIPS demonstrated significant benefits over repeated thoracentesis as it was associated with a lower risk of sepsis, AKI, hyponatremia, pneumothorax, empyema, SBP and need for LT in patients with HH. However the increased risk of hepatic encephalopathy associated with TIPS warrants careful patient selection and close monitoring.