Comparison of treatment of hepatic hydrothorax with catheter drainage versus serial thoracentesis.

PURPOSE OF REVIEW: Hepatic hydrothorax is a nonmalignant pleural effusion associated with portal hypertension that may cause increased morbidity or mortality in cirrhotic patients. For patients who are refractory to salt restriction and diuretics, thoracentesis and catheter drainage are necessary for symptomatic relief. This review aimed to identify the best drainage method in patients with hepatic hydrothorax. RECENT FINDINGS: Chest tube placement is discouraged in cases of hepatic hydrothorax due to high complication and mortality rates. Although the complication rate associated with smaller caliber catheter drainage appears lower than with chest tube drainage, patients treated with catheter drainage still had a higher 30-day mortality compared with patients treated by thoracentesis. Catheter drainage was an independent risk factor for 30-day mortality in cirrhotic patients with pleural effusion after adjusting for age, hepatic dysfunction, and other comorbidities. Treating the underlying disorder with liver transplantation can dramatically improve survival in these patients. SUMMARY: The recent evidence supports series thoracentesis as the first-line drainage method in cases of hepatic hydrothorax compared with catheter drainage. Further prospective, randomized, controlled trials are necessary to further evaluate the mortality and complication rates of catheter drainage compared with thoracentesis in cirrhotic patients.

CHA2DS2-VASc scores predict major adverse cardiovascular events in patients with chronic obstructive pulmonary disease.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) frequently experience concurrent comorbidities; therefore, risk assessment for major adverse cardiovascular events (MACEs) is very important. OBJECTIVES: We explored the association between COPD and risk of MACEs with three common clinical events: acute myocardial infarction (AMI), ischemic stroke (IS), and cardiovascular death (CVD). METHODS: We evaluated the predictive value of the CHA2DS2-VASc score (congestive heart failure [C], hypertension [H], age [A], diabetes [D], stroke [S], and vascular disease [VASc]) for MACEs in COPD patients. In this observational study, we retrospectively reviewed the records of 29 258 patients with COPD between 2005 and 2009 in relation to MACE risk using the CHA2DS2-VASc score. We calculated the hazard ratios (HR) and 95% confidence intervals (CI) using a significance level of .05. RESULTS: Patients with COPD had significantly (P < .001) increased risk of MACEs, and a high prevalence of CHA2DS2-VASc scores ≥ 6, predicting MACEs (16.1%), AMI (3.3%), IS (8.7%), and CVD (4.0%). A good discrimination was found for MACEs, IS events, and CVD events (AUC = 0.740, 0.739, and 0.778, respectively) but poorer discrimination for AMI events (AUC = 0.697). CONCLUSION: Early lifestyle modifications and antithrombotic therapy may be essential for COPD patients at a high risk of MACEs, that is, those with CHA2DS2-VASc scores ≥ 6.