{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:10:32Z","timestamp":1785168632432,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T00:00:00Z","timestamp":1566172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pleural effusions (PE) complicate cirrhosis in ~5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large\u2010scale studies on interventions for refractory PE are limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive hospitalized cirrhotics having PE were retrospectively analysed. None had liver transplantation (LT) within 6\u2010month follow\u2010up. We determined safety, efficacy and mortality predictors for PE managed with standard medical treatment (SMT), thoracentesis, catheter drainage and TIPS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1149 cirrhotics with PE (mean Child\u2010Pugh 10.6\u00a0\u00b1\u00a01.8 and MELD 21.2\u00a0\u00b1\u00a07.4), 82.6% had hepatic hydrothorax (HH) and 12.3% were suspected tubercular PE (TBPE). Despite comparable HVPG and MELD scores, patients with HH developed more AKI, encephalopathy and septic shock (all <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) on follow\u2010up. Among HH, 73.5% were symptomatic, 53.2% isolated right\u2010sided PE and 21.3% had SBE. Presence of SBP [Odd's ratio, OR: 4.5] and catheter drainage [OR: 2.1] were independent predictors for SBE. In 70.3% of admissions, HH responded to SMT alone, 12.9% required thoracentesis and 11.5% underwent catheter drainage. Fifty\u2010one patients were selected for TIPS [lower mean CTP 9.9\u00a0\u00b1\u00a01.6 and MELD score 18.7\u00a0\u00b1\u00a05.4]. Despite reduction in pressure gradient from 23.1\u00a0\u00b1\u00a03.8\u00a0mm\u00a0Hg to 7.2\u00a0\u00b1\u00a02.5\u00a0mm\u00a0Hg, 25 patients had partial response, 10 had complete HH resolution. Major post\u2010TIPS complications were portosystemic encephalopathy (eight patients, six resolved) and ischaemic hepatitis (four patients, two resolved). Overall, 35.9% patients with HH had 6\u2010month mortality and independent predictors were MELD\u00a0&gt;\u00a025, SBP and septic shock.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Refractory PE in cirrhosis requiring interventions including TIPS has poor outcome. The role of haemodynamics in predicting post\u2010TIPS response and complications is limited. Early referral for LT is imperative.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14200","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T17:13:27Z","timestamp":1564420407000},"page":"2164-2173","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Efficacy and safety of transjugular intrahepatic portosystemic shunt in difficult\u2010to\u2010manage hydrothorax in cirrhosis"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5582-7759","authenticated-orcid":false,"given":"Ankur","family":"Jindal","sequence":"first","affiliation":[{"name":"Department of Hepatology Institute of Liver &amp; Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8905-5889","authenticated-orcid":false,"given":"Amar","family":"Mukund","sequence":"additional","affiliation":[{"name":"Departments of Intervention Radiology Institute of Liver &amp; Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guresh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Clinical Research Institute of Liver &amp; Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0544-5610","authenticated-orcid":false,"given":"Shiv K.","family":"Sarin","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver &amp; Biliary Sciences New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v22.i26.6008"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0b013e328352b50f"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)00744-6"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201603-223ED"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.193227"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.634"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-014-9580-2"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11373-005-9014-1"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2015.01.003"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2016.0056"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2002.31250"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.05.022"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002255"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.06.013"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.1.142"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000484"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2010.02447.x"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1382790"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-016-4260-9"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000386"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.14200","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.14200","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.14200","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T12:05:30Z","timestamp":1694174730000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.14200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,19]]},"references-count":20,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019,11]]}},"alternative-id":["10.1111\/liv.14200"],"URL":"https:\/\/doi.org\/10.1111\/liv.14200","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,19]]},"assertion":[{"value":"2018-11-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}