Resistant ascites in liver cirrhosis: a comparative analysis of pathogenetically based treatment approaches

Introduction. Ascites significantly impacts the prognosis of liver cirrhosis (LC). Current treatment methods are effective but have side effects. A comparative evaluation of these approaches will help personalize treatment strategies and improve outcomes in LC patients. Objective. To compare the efficacy and safety of pathogenetically justified treatments for refractory ascites in patients with liver cirrhosis. Materials and Methods. The study, conducted at the Botkin Hospital, Moscow, included 92 patients with LC and ascites, divided into three treatment protocols: Group 1 (n=35) received diuretic therapy, Group 2 (n=31) underwent transjugular intrahepatic portosystemic shunt (TIPS), and Group 3 (n=26) received combination therapy with Terlipressin 1000 mcg/day plus Furosemide 40–200 mg/day. The groups were comparable in sex and age; the mean MELD score was 13±2,6 in Group 1, 14,13±3,51 in Group 2, and 15,15±3.4 in Group 3. Monitoring was performed at baseline, after 14 days, 30 days, and then every 2 months for one year. Compensation criteria included no progression of ascites or signs of liver decompensation. One-year mortality was assessed. Results. In Group 1, the compensation period lasted 31,2±10,31 weeks with a mortality rate of 26 % (9 patients). Group 2 showed a significantly longer compensation duration of 41,5±13,17 weeks compared to Group 1 (p<0,05), though hepatic encephalopathy worsened in 17 patients (54,8 %) within one month, with a mortality rate of 10 % (3 cases). In Group 3, the compensation period was 37,4±11,4 weeks, also significantly longer than in Group 1 (p=0,012), with an 11 % mortality rate (3 cases). These findings demonstrate that pathogenetically targeted treatments for ascites significantly prolong the compensation period in patients with liver cirrhosis.