Natural history of grade 1 ascites in patients with liver cirrhosis

Authors Theodoros Theodorakopoulos, Maria Kalafateli, Georgios N. Kalambokis, Dimitrios N. Samonakis, Ioanna Aggeletopoulou, Chrysostomos Tsolias, Aikaterini Mantaka, Paraskevi Tselekouni, Georgia Vourli, Stelios F. Assimakopoulos, Charalampos Gogos, Konstantinos Thomopoulos, Haralampos Milionis, Christos Triantos.


Background No evidence is available on the natural history of grade 1 ascites and its progression to grade 2/3 in patients with liver cirrhosis. The aim of the current study was to address this issue, to assess the development of main comorbid disorders closely related to ascites progression, and to identify the predictive factors for survival in this setting.

Methods Consecutive Caucasian cirrhotic patients with grade 1 ascites were retrospectively analyzed. None of patients was under treatment with diuretics at diagnosis. Control groups consisted of 145 cirrhotics with grade 2/3 ascites and 175 cirrhotics without ascites.

Results Diuretics were initiated in 58 patients with grade 1 ascites at baseline by the attending physician. At the last follow up, 29 patients had no ascites, 33 patients had grade 1 and 38 patients had grade 2/3 ascites. No variable was found to be an independent predictor of grade 2/3 ascites. Seven patients developed spontaneous bacterial peritonitis while under treatment with diuretics; at that time only 1 patient had grade 1 ascites. The mortality rate was similar among all examined groups.

Conclusions This study suggests that the presence of grade 1 ascites does not constitute a precursor of grade 2/3 ascites in patients with cirrhosis. Thus, patients with grade 1 ascites do not require specific treatment with diuretics.

Keywords Ascites, grade 1, natural history, liver cirrhosis

Ann Gastroenterol 2021; 34 (1): 93-103

Original Articles