P2346 - Early vs Delayed Diagnostic Paracentesis in Hospitalized Patients With Cirrhosis and Ascites: A Systematic Review and Meta-Analysis

Azizullah Beran, MD¹, Mouhand FH. Mohamed, MD², Alejandra Vargas, MD³, Tarek Aboursheid, MD⁴, Mohamad Nawras, BS⁵, Fouad Jaber, MD⁶, Ruben Hernaez, MD, MPH, PhD⁷, Kavish Patidar, MD⁷, Lauren Nephew, MD¹, Archita Desai, MD¹, Eric Orman, MD¹, Marwan Ghabril, MD^1
1Indiana University, Indianapolis, IN; ²Brown University, Providence, RI; ³Eastern Virginia Medical School, Norfolk, VA; ⁴Ascension Saint Francis Hospital, Chicago, IL; ⁵University of Toledo College Medicine and Life Sciences, Toledo, OH; ⁶University of Missouri-Kansas City, Kansas City, MO; ⁷Baylor College of Medicine, Houston, TX

Introduction: Guidelines recommend performing early diagnostic paracentesis (DP) for all hospitalized cirrhotic patients with ascites. However, adherence to this recommendation is suboptimal. The effects of this overlooked quality indicator on the clinical outcomes of hospitalized patients with cirrhosis and ascites remains unclear. In this meta-analysis, we aimed to assess the outcomes of early DP vs. delayed DP among hospitalized patients with cirrhosis and ascites.

Methods: We performed a comprehensive search in PubMed, Embase, and Cochrane databases to include all eligible studies that compared the outcomes of early DP vs. delayed DP among hospitalized patients with cirrhosis and ascites. The random-effects model was used to calculate the pooled odds ratio (OR) and mean difference (MD) with the corresponding confidence intervals (CI) for proportional and continuous variables, respectively. Early DP was defined as receiving DP within 12-24 hours of admission. The primary outcome was in-hospital mortality. Secondary outcomes were hospital length of stay (LOS), and acute kidney injury (AKI). Subgroup analysis was performed based on the timing of EDP (within 12 hours vs. 24 hours of admission) for the primary outcome.

Results: Seven studies involving 88,362 hospitalized patients with cirrhosis and ascites (51,939 received early DP vs. 36,423 received delayed DP) were included. Early DP was associated with lower in-hospital mortality (OR 0.63, 95% CI 0.52-0.76, p< 0.00001, I²=68%, Figure 1A), LOS (MD -4.85; 95% CI -6.45, -3.26; 0.72; p< 0.00001; I²=95%; Figure 1B), and AKI (OR 0.62, 95% CI 0.42-0.92, p=0.02, I²=55%, Figure 1C) compared to delayed DP. There was a trend toward lower in-hospital mortality with early DP within 12 hours of admission (OR 0.38, 95% CI 0.21-0.67, p=0.0009, I²=0%) compared to 24 hours of admission (OR 0.66, 95% CI 0.55-0.80, p< 0.0001, I²=76%), but the test of the subgroup difference did not reach statistical significance (test of subgroup differences: χ²=3.35, degree of freedom=1, p=0.07, Figure 2).

Discussion: Early DP is associated with lower in-hospital mortality, LOS, and AKI in hospitalized patients with cirrhosis and ascites. Early DP should be conducted in any patient with cirrhosis and ascites upon hospital admission due to its positive effect on clinical outcomes. Future research must examine the obstacles to early DP in hospitalized patients with cirrhosis and ascites.



Disclosures:


Azizullah Beran, MD¹, Mouhand FH. Mohamed, MD², Alejandra Vargas, MD³, Tarek Aboursheid, MD⁴, Mohamad Nawras, BS⁵, Fouad Jaber, MD⁶, Ruben Hernaez, MD, MPH, PhD⁷, Kavish Patidar, MD⁷, Lauren Nephew, MD¹, Archita Desai, MD¹, Eric Orman, MD¹, Marwan Ghabril, MD¹. P2346 - Early vs Delayed Diagnostic Paracentesis in Hospitalized Patients With Cirrhosis and Ascites: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.