Leptin levels in the differential diagnosis between benign and malignant ascites

AIM： To evaluate the role of leptin levels in the differentia diagnosis of ascites. METHODS： Ascitic leptin, TNFα and serum leptin levels were measured in 77 patients with ascites （35 with malignancies, 30 cirrhosis and 12 tuberculosis）. Control serum samples were obtained from 20 healthy subjects. Leptin and TNFα levels were measured by EUSA. Body mass index （BMI） and percentage of body fat （BFM） by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients. RESULTS： In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFα levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. CONCLUSION： In patients with malignant ascites, levels of leptin and TNFα were significantly lower than in patients with tuberculous ascites.

Chemotherapy with laparoscope-assisted continuous circulatory hyperthermic intraperitoneal perfusion for malignant ascites

AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparoscopeassisted perfusion catheters placing. The first session was completed in operative room under general anesthesia, 5% glucose solution was selected as perfusion liquid, and 1500 mg 5 fluorouracil (5FU) and 200 mg oxaliplatin were added in the perfusion solution. The second andthird sessions were performed in intensive care unit, 0.9% sodium chloride solution was selected as perfusion liquid, and 1500 mg 5FU was added in the perfusion solution alone. CHIPC was performed for 90 min at a velocity of 450600 mL/min and an in flow temperature of 43 ± 0.2℃.RESULTS: The intraoperative course was uneventful in all cases, and the mean operative period for laparoscopeassisted perfusion catheters placing was 80 min for each case. No postoperative deaths or complications related to laparoscopeassisted CHIPC occurred in this study. Clinically complete remission of ascites and related symptoms were achieved in 14 patients, and partial remission was achieved in 2 patients. During the followup, 13 patients died 29 mo after CHIPC, with a median survival time of 5 mo. Two patients with partial remission suffered from port site seeding and tumor metastasis,and died 2 and 3 mo after treatment. Three patients who are still alive today survived 4, 6 and 7 mo, respectively. The Karnofsky marks of patients (5090) increased significantly (P < 0.01) and the general status improved after CHIPC. Thus satisfactory clinical efficacy has been achieved in these patients treated by laparoscopic CHIPC. CONCLUSION: Laparoscopeassisted CHIPC is a safe, feasible and effective procedure in the treatment of debilitating malignant ascites induced by unresectable gastric cancers.

Expression and significance of cyclooxygenase-2 mRNA in benign and malignant ascites

AIM:To investigate the mRNA expression of cyclooxygensae-2(COX-2)in benign and malignant ascites,and to explore the difference in COX-2 mRNA expression among different diseases.METHODS:A total of 36 samples were collected from the Fifth Affiliated Hospital of Sun Yat-Sen University and divided into two experimental groups:benign ascites(n=21)and malignant ascites(n=15).Benign ascites included cirrhotic ascites(n=10)and tuberculous ascites(n=5).Malignant ascites included oophoroma(n=7),cancer of colon(n=5),cancer of the liver(n=6),gastric cancer(n=2),and bladder carcinoma(n=1).The mRNA expression of COX-2 in ascites was examined with reverse transcriptase polymerase chain reaction(RT-PCR)technology,and the positive rate of COX-2 mRNA was compared between different diseases.RESULTS:The positive rate of COX-2 mRNA in malignant ascites was 42.9%(9/21),which was significantly higher than in benign ascites,6.7%(1/15),difference being significant between these two groups(χ2=4.051,P=0.044).The proportion of the positive rate in the malignant ascites was as follows:ovarian cancers57.1%(4/7),colon cancer 40.0%(2/5),liver cancer33.3%(2/6),gastric cancer 50.0%(1/2),and bladder cancer 0.00%(0/1).However,there was no significant difference in COX-2 mRNA expression among various tumors with malignant ascites(χ2=1.614,P=0.806).Among the benign ascites,COX-2 mRNA levels were different between the tuberculous ascites(0/5)and cirrhotic ascites(1/10),but there was no significant difference(P=1.000).CONCLUSION:COX-2 mRNA,detected by RT-PCR,is useful in the differential diagnosis of benign and malignant ascites,which also has potential value in the clinical diagnosis of tumors.

Evaluation and treatment of malignant ascites secondary to gastric cancer

Malignant ascites affects approximately 10% of patients with gastric cancer(gC), and poses significant difficulties for both patients and clinicians. In addition to the dismal general condition of affected patients and the diversity of associated complications such as jaundice and ileus, problems in assessing scattered tumors have hampered the expansion of clinical trials for this condition. However, the accumulation of reported studies is starting to indicate that the weak response to treatment in g C patients with malignant ascites is more relevant to their poor prognosis rather than to the ascites volume at diagnosis. Therefore, precise assessment of initial state of ascites, repetitive evaluation of treatment efficacy, selection of suitable treatment, and swift transition to other treatment options as needed are paramount to maximizing patient benefit. Accurately determining ascites volume is the crucial first step in clinically treating a patient with malignant ascites. Ultrasonography is commonly used to identify the existence of ascites, and several methods have been proposed to estimate ascites volume. Reportedly, the sum of the depth of ascites at five points(named "five-point method") on three panels of computed tomography images is well correlated to the actual ascites volume and/or abdominal girth. This method is already suited to repetitive assessment due to its convenience compared to the conventional volume rendering method. Meanwhile, a new concept, "Clinical Benefit Response in g C(CBR-GC)", was recently introduced to measure the efficacy of chemotherapy for malignant ascites of g C. CBR-GC is a simple and reliable patient-oriented evaluation system based on changes in performance status and ascites, and is expected to become an important clinical endpoint in future clinical trials. The principal of treatment for g C patients with ascites is palliation and prevention of ascites-related symptoms. The treatment options are various, including a standard treatment based on the available guidelines, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(HIPEC), laparoscopic HIPEC alone, intravenous chemotherapy, intraperitoneal chemotherapy, and molecular targetingtherapy. Although each treatment option is valid,further research is imperative to establish the optima choice for each patient.

Role of Th9 cells and Th17 cells in the pathogenesis of malignant ascites

Objective: To assess the role of Th9 and Th17 cells in malignant ascites(MA).Methods: MA from 30 hepatic carcinoma patients and benign ascites from 30 cirrhotic patients were collected. Corresponding peripheral blood samples from these hepatic carcinoma and cirrhotic patients as well as 30 healthy subjects were collected. The frequency of Th9 and Th17 cells was tested by flow cytometry. Serum levels of interleukin(IL)-9 and IL-17 were examined by ELISA.Results: The observed frequency of Th9 and Th17 cells, and the IL-9 and IL-17 serum levels were significantly higher in MA patients than those in cirrhotic patients and healthy control samples(P < 0.05). Moreover, the Th9 cells demonstrated positive correlation with Th17 cells as well as IL-9 in MA patients; however, this positive correlation was not observed in the cirrhotic patients or healthy control samples. The frequency of Th9 and Th17 cells was distinctly higher in MA patients presenting with stage III or IV malignancy and with lymph node or distant metastasis than those in patients in stage I or II and without distant metastasis(P < 0.05).Conclusions: The increased frequency of Th9 and Th17 cells in MA patients suggests that these two T cell subsets play a synergistic role in MA pathogenesis. This study also demonstrated that Th9 and Th17 cells may perform their biological functions in conjunction with IL-9 production.

Prognostic significance of malignant ascites in gastric cancer patients with peritoneal metastasis: A systemic review and meta-analysis

BACKGROUND Recent evidence indicates that malignant ascites may be associated with the high malignancy and poor prognosis of gastric cancer(GC)with peritoneal metastasis(PM),but no robust consensus has been reached until now.AIM To evaluate the prognostic significance of malignant ascites in GC patients with PM.METHODS Two independent authors conducted database searches.The searches were performed in the EMBASE,PubMed,and Cochrane Library databases,and the terms used to search included stomach neoplasms,GC,ascites,peritoneal effusion,survival,and survival analysis.Outcomes included overall survival and hazard ratios with 95%confidence intervals(CIs).Three pairs of comparisons for measuring survival were made:(1)Patients with ascites vs those without ascites;(2)Patients with massive ascites vs those with mild to moderate ascites;and(3)Patients with massive ascites vs those with no to moderate ascites.RESULTS Fourteen articles including fifteen studies were considered in the final analysis.Among them,nine studies assessed the difference in prognosis between patients with and without malignant ascites.A pooled HR of 1.63(95%CI:1.47-1.82,P<0.00001)indicated that GC patients with malignant ascites had a relatively poor prognosis compared to patients without ascites.We also found that the prognosis of GC patients with malignant ascites was related to the volume of ascites in the six other studies.CONCLUSION GC patients with malignant ascites tend to have a worse prognosis,and the volume of ascites has an impact on GC outcomes.

Pharmacokinetic study of paclitaxel in malignant ascites from advanced gastric cancer patients

AIM： To examine the paclitaxel concentrations in plasma and ascites after its intravenous administration in patients with ascites due to peritonitis carcinomatosa resulting from advanced gastric cancer. METHODS： Two patients with ascites due to peritonitis carcinomatosa resulting from gastric cancer were included in this study. The paclitaxel concentrations in plasma and ascites were investigated for 72 h in case 1 and 168 h in case 2 after intravenous administration. RESULTS： The paclitaxel concentration in plasma peaked immediately after administration, followed by rapid decrease below the threshold value of 0.1 μmol （85 ng/mL） within 24 h. In contrast, the paclitaxel concentration in ascites increased gradually for 24 h after administration to a level consistent with the level found in plasma. After 24 h the level of paclitaxel in ascites and plasma became similar, with the optimal level being maintained up to 72 h following administration. CONCLUSION： The concentration of paclitaxel in ascites is maintained within the optimal level for the treatment of cancer cells for up to 72 h after intravenous administration. Paclitaxel is a promising drug for the treatment of malignant ascites of gastric cancer.

Use of ^(18)F-FDG PET/CT to locate primary malignancies in patients with hepatic cirrhosis and malignant ascites

Objective：Ascites in patients with hepatic cirrhosis is caused by cirrhosis in most cases.For most malignant ascites,the primary malignancy could be readily identified using conventional imaging methods,e.g.,computer tomography （CT） and magnetic resonance imaging （MRI）.However,in a small fraction of the patients,the primary malignancy remains occult even with these examinations.In this retrospective study,we assessed the usefulness of 18F-FDG PET/CT in patients with hepatic cirrhosis and malignant ascites of otherwise unknown origin.Methods：Twenty-eight patients with malignant ascites of unknown primary sites after CT,MRI and ultrasound during the period of five years between January 2008 and December 2012 had received 18F-FDG PET/CT.Medical records of these patients were reviewed and analyzed.Results：Elevated 18F-FDG absorption was found in 23 of 28 cases in the following sites：gastrointestinal tract （n=10,43.5％）,prostate （n=5,21.7％）,peritoneum （n=4,13.3％）,and ovary （n=4,13.3％）.Cancer was confirmed by pathology in 20 cases after open or laparoscopic surgeries.Five patients were found to have benign ascites,among which,3 were found to be false positive due to tuberculosis.SUV values were significantly higher for tumors than for benign lesions （mean values,6.95 vs.2.94; P=0.005）.Conclusions：The 18F-FDG PET/CT can be as a powerful imaging tool in identifying tissue origin in liver cirrhosis patients suspected of cancers or with cancers of unknown primary sites.

Respiratory distress due to malignant ascites palliated by hyperthermic intraperitoneal chemotherapy

Malignant ascites is a common symptom in patients with peritoneal cancer. Current assumption is that anincreased vascular permeability and obstruction of lymphatic channels lead to the accumulation of fluid in the abdominal cavity. This case report describes a severely symptomatic patient with malignant ascites. The previously healthy 73-year-old male was presented with abdominal distention causing respiratory distress. Computed tomography revealed large amounts of ascites, a recto-sigmoidal mass with locoregional lymphadenopathy and an omental cake. Biopsy taken during colonoscopy revealed an adenocarcinoma of the colon with signet cell differentiation. A widespread peritoneal carcinomatosis was found during a diagnostic laparoscopy. The extent of peritoneal disease rendered the patient not suitable for cytoreductive surgery with curative intent. The ascites proved to be refractory to ultrasound-guided paracentesis; thus, a decision was made to perform palliative hyperthermic intraperitoneal chemotherapy without cytoreductive surgery. Consequently, ascites production stopped, and the respiratory distress was relieved thereafter. The postoperative recovery was uneventful. Ascites recurred eight months later, and a second hyperthermic intraperitoneal chemotherapy procedure was performed. The patient was still alive at the time of writing, 16 mo after the initial diagnosis.

Cancer-derived VEGF plays no role in malignant ascites formation in the mouse

AIM: Vascular endothelial growth factor (VEGF) is a potent mediator of peritoneal fluid accumulation following tumor progression. This study investigated the role of VEGF secreted by cancerous cells in the formation of malignant ascites.METHODS: VEGF expression was eliminated byknockdown in the pancreas cancer cell-line PancO2 using vector-based short-hairpin type RNA interference (RNAi).Malignant ascites formation in the mouse was analyzed by intraperitoneal injection of PancO2 cells expressing VEGF or with expression knockdown.RESULTS: The VEGF knockdown PancO2 cell was successfully established. Knockdown of VEGF did not affect cancer cell proliferation in vitro or in vivo. The volume of ascites following peritoneal expansion of the tumor in VEGF knockdown cells and control cells did not differ statistically in this in vivo study. Moreover, the VEGF concentration in the ascites did not differ statistically.CONCLUSION: Malignant ascites formation might be mediated by VEGF production in noncancerous tissues,such as stromal compartments. An anti-VEGF strategy against malignant ascites could be applied to various tumors regardless of whether they secrete VEGF.

Influence of SLYWG on malignant tumor ascites

Objective To search the effect of Chinese traditional medicine "Shang Lu Yu Wang Gao"(SLYWG)on the ascites induced by tumor,and its mechanism.Methods The tumor ascites model and diuretic experiments were introduced to evaluate the effect of SLYWG.Physical characteristics,the tumor cell counting,volume of the ascites,protein content in ascites,the characters of ascites,the life duration of S180 tumor bearing animals as the indexes of evaluation.the diurtic experiments were performed on rats nad rabbits,the osmotic pressure,K+,Na+,Cl-,Ca2+ and pH in urine were determined.Results The inhibitions to ascites of SLYWG were displayed in three dosage(30 g·kg-1,15 g·kg-1 and 7.5 g·kg-1).Ascites caused by tumor was significantly inhibited by the local administration of SLYWG.The increase of mice ascites was slow down,the content of ALB and the TP in ascites were decreased,the surviving time of mice was extended.SLYWG had remarkable diuresis effect on the rats and rabbits,it could reduce the osmotic pressure of urine,decrease the exclude of K+ but had no effect on the Na+,Cl-,Ca2+ and pH in urine.Conclusions Tumor ascites was significantly inhibited by the ventral administration of SLYWG.SLYWG had diuretic effect in rats and rabbits,it reduced the osmotic pressure of urine,decrease the exclude of K+ but had no effect on Na+,Cl-,Ca2+ and pH of urine.

Leukemoid Reaction and Malignant Ascites in a Renal Carcinoma with Sarcomatoid Differentiation. Unusual Case Report and Literature Review

Renal cell carcinoma represents the 16th cause of death by cancer. It is one of the most frequent kidney tumors. This tumor could behave as a good mimicker, and is frequently associated with paraneoplastic syndromes. Metastases to peritoneum, mesentery or omentum are very rare. Sarcomatoid renal cell carcinoma is a high-grade undifferentiated component that can be found in any subtypes of renal cell carcinoma, and is associated with an aggressive behavior and a poor prognosis. We present the case of a 59-year-old male, diabetic patient, with nephron preserved left nephrectomy through lumbotomy seven years ago, upper pole renal carcinoma, admitted to the emergency department with indeterminate shock. He underwent a diagnostic laparoscopy and then open surgery due to findings where a greater omentum subtotal infarction. Omentum microscopic examination resulted in vaguely differentiated neoplasia, with sarcomatoid like cells, highly positive to CD10 inmunolabeling. Even though renal cell carcinomas have unusual clinical presentations, this case is unique because of the convergence of extremely rare manifestations such as the combination of malignant ascites, peritoneal carcinomatosis, and contralateral suprarenal gland metachronous metastases at the major omentum with paraneoplastic syndrome type leukemoid reaction;which have not been reported previously in literature.

Drainage of ascites in cirrhosis

For cirrhotic refractory ascites,diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management.However,their therapeutic effects are limited,and most refractory ascites do not respond to medication treat-ment,necessitating consideration of drainage or surgical interventions.Con-sequently,numerous drainage methods for cirrhotic ascites have emerged,including large-volume paracentesis,transjugular intrahepatic portosystemic shunt,peritoneovenous shunt,automated low-flow ascites pump,cell-free and concentrated ascites reinfusion therapy,and peritoneal catheter drainage.This review introduces the advantages and disadvantages of these methods in different aspects,as well as indications and contraindications for this disease.

Influence of intraperitoneal perfusion chemotherapy combined with deep hyperthermia on the malignant molecule expression in ascites of patients with ovarian cancer complicated by ascites

Objective: To explore the influence of intraperitoneal perfusion chemotherapy combined with deep hyperthermia on the malignant molecule expression in ascites of patients with ovarian cancer complicated by ascites. Methods: A total of 80 patients with ovarian cancer complicated by ascites who were treated in this hospital between March 2015 and January 2017 were retrospectively analyzed and divided into the control group (n=43) and the study group (n=37). Control group received intraperitoneal perfusion chemotherapy and study group underwent intraperitoneal perfusion chemotherapy combined with deep hyperthermia. The differences in the expression of proliferation, invasion, autophagy and other malignant molecules in ascites were compared between the two groups before and after treatment. Results: Before treatment, the differences in the expression of proliferation, invasion, autophagy and other malignant molecules in ascites were not statistically significant between the two groups. After treatment, proliferation gene TCEAL7 mRNA expression in ascites of study group was higher than that of control group whereas Clusterin, HOTAIR, ROCK and TNFAIP8 mRNA expression were lower than those of control group;invasion gene DUSP10 mRNA expression in ascites was higher than that of control group whereas MTA1, Nek2, Stathmin and IFITM1 mRNA expression were lower than those of control group;autophagy genes LC3-Ⅱ, Beclin1 and PTEN mRNA expression in ascites were higher than those of control group. Conclusion:Intraperitoneal perfusion chemotherapy combined with deep hyperthermia can effectively balance the expression of proliferation, invasion and autophagy genes in ascites, and ultimately reduce the malignancy of the tumor in patients with ovarian cancer complicated by ascites.

Influence of Aidi injection combined with paclitaxel and platinum drugs on malignant molecule expression in malignant ascites of patients with advanced gastric cancer

Objective: To explore the influence of Aidi injection combined with paclitaxel and platinum drugs on malignant molecule expression in malignant ascites of patients with advanced gastric cancer. Methods: A total of 80 patients with advanced gastric cancer complicated by malignant ascites who were treated in the hospital between January 2015 and December 2016 were divided into control group and observation group by random number table, each with 40 cases. Control group were treated with paclitaxel and platinum drugs, and observation group were treated with Aidi injection combined with paclitaxel and platinum drugs. The differences in the malignant molecule expression in malignant ascites were compared between the two groups of patients before and after treatment. Results: Before treatment, the proliferation, invasion and autophagy gene expression in malignant ascites were not statistically different between the two groups of patients. 1 week after treatment, EZH2, I2PP2A, Gal-1, HPA-1, MTA1, TROP2, BNIP3 and LC3 mRNA expression in malignant ascites of both groups of patients were lower than those before treatment while PTPN13, TRIM28, SOX7, Syndecan-1 and Beclin1 mRNA expression were higher than those before treatment, and EZH2, I2PP2A, Gal-1, HPA-1, MTA1, TROP2, BNIP3 and LC3 mRNA expression in malignant ascites of observation group were lower than those of control group while PTPN13, TRIM28, SOX7, Syndecan-1 and Beclin1 mRNA expression were higher than those of control group. Conclusion: Aidi injection combined with paclitaxel and platinum drugs can effectively inhibit the gastric cancer cell proliferation and invasion, and regulate cell autophagy activity in the malignant ascites of patients with advanced gastric cancer.

Spontaneous Infection of Ascites Fluid at the National and University Hospital Hubert Koutoukou Maga in Cotonou: Prevalence and Associated Factors

Background: Spontaneous ascites fluid infection (SAFI) is an extremely serious and frequently encountered complication in cirrhotic patients. We aimed to determine the prevalence of SAFI and the factors associated with it in the largest hospital in Cotonou. Methods: This was a retrospective descriptive and analytical study conducted from January 2013 to July 2019, at the National and University Hospital Hubert Koutoukou Maga (CNHU-HKM) in Cotonou, Benin. All patients followed in the University Clinic of Hepato-Gastroenterology and diagnosed with SAFI were included. Results: Eighty-two patients were included, predominantly males (69.5%), with a mean age of 51.5 ± 14.5 years. Among them, 32 had SAFI, i.e., a prevalence of 39%. Of the 32 cases of SAFI, the culture of ascites fluid was positive in 6 cases (18.7%). The most frequent germ found in SAFI was Escherichia coli (5 patients, 83.3%). The factors associated with SAFI in this study were: abdominal pain (p = 0.004), increased bilirubinemia (p = 0.009), decreased prothrombin level 20 (p = 0.001). Conclusion: SAFI was common in cirrhotic patients in the department. Certain clinical and paraclinical factors were associated with it, as was the severity of cirrhosis. Early diagnosis and aetiological management of cirrhosis could reduce its frequency.

Hepatic perivascular epithelioid cell tumors:Benign,malignant,and uncertain malignant potential

In 2013,the World Health Organization defined perivascular epithelioid cell tumor(PEComa)as“a mesenchymal tumor which shows a local association with vessel walls and usually expresses melanocyte and smooth muscle markers.”This generic definition seems to better fit the PEComa family,which includes angiomyolipoma,clear cell sugar tumor of the lung,lymphangioleiomyomatosis,and a group of histologically and immunophenotypically similar tumors that include primary extrapulmonary sugar tumor and clear cell myomelanocytic tumor.Clear cell tumors with this immunophenotypic pattern have also had their malignant variants described.When localizing to the liver,preoperative radiological diagnosis has proven to be very difficult,and most patients have been diagnosed with hepatocellular carcinoma,focal nodular hyperplasia,hemangioma,or hepatic adenoma based on imaging findings.Examples of a malignant variant of the liver have been described.Finally,reports of malignant variants of these lesions have increased in recent years.Therefore,we support the use of the Folpe criteria,which in 2005 established the criteria for categorizing a PEComa as benign,malignant,or of uncertain malignant potential.Although they are not considered ideal,they currently seem to be the best approach and could be used for the categorization of liver tumors.

Single-cell landscape of malignant ascites frompatients with metastatic colorectal cancer

The presence of malignant ascites in colorectal cancer(CRC)patients is associated with a poor prognosis,a high risk of recurrence,and resistance to chemotherapy and immune therapy[1–3].Understanding the complex interactions among different kinds of cells and the ecosystem of peritoneal metastasized colorectal cancer(pmCRC)ascites may provide insights into effective treatment strategies.

Clinical study on the relationship between liver cirrhosis,ascites,and hyponatremia

BACKGROUND Cirrhosis is a common liver disease,and ascites is one of the common clinical conditions.However,the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied.AIM To explore the clinical manifestations,prognostic factors,and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies.METHODS In this study,we retrospectively analyzed the clinical data of 150 patients diagnosed with cirrhosis and ascites between 2017 and 2022.Patients were divided into two groups:ascites combined with hyponatremia group and ascites group.We compared the general characteristics,degree of hyponatremia,complications,treatment,and prognosis between the two groups.RESULTS In the study results,patients in the ascites combined with hyponatremia group showed an older average age(58.2±8.9 years),64.4%were male,and had a significantly longer hospitalization time(12.7±5.3 d).Hyponatremia was more severe in this group,with a mean serum sodium concentration of 128.5±4.3 mmol/L,which was significantly different from the ascites group of 137.6±2.1 mmol/L.Patients with ascites and hyponatremia were more likely to develop hepatic encephalopathy(56.2%vs 39.0%),renal impairment(45.2%vs 28.6%)and infection(37.0%vs 23.4%).Regarding treatment,this group more frequently used diuretics(80.8%vs 62.3%)and salt supplements(60.3%vs 38.9%).Multiple logistic regression analysis identified older age[Odds ratio(OR)=1.06,P=0.025]and male gender(OR=1.72,P=0.020)as risk factors for hyponatremia combined with ascites.Overall,patients with ascites and hyponatremia present a clear high-risk status,accompanied by severe complications and poor prognosis.CONCLUSION In patients with cirrhosis,ascites with hyponatremia is a high-risk condition that is often associated with severe complications.