Management of ascites in elderly patients with cirrhosis: Results of an Italian survey

Ascites is the most common cause of decompensation in cirrhosis. Elderly patients with cirrhosis usually have multiple comorbidities, which can be a barrier to many therapeutic options. Therefore, the treatment choices available to these patients are limited and must be carefully selected on a case-by-case basis. In order to explore the management of ascites in elderly patients with cirrhosis in real-life, we conducted a survey among members of the AISF in July 2024, concerning patients with cirrhosis aged >70 years with ascites. Physicians were invited to anonymously answer 49 questions on several topics. Data from 22 centers revealed that approximately 20 % of these patients had intractable ascites, primarily caused by renal failure, hypotension, and hepatic encephalopathy. Diuretics were used in 62 % of cases, while advanced therapies such as TIPS or transplantation were rare due to frailty and comorbidities. The dose and frequency of home albumin infusion was heterogeneous across centers, showing a non-uniform approach. Malnutrition was reported in nearly 50 % of patients, but nutritional interventions were limited. Non-academic centers reported reduced availability to different therapeutic options, highlighting disparities in care. This study underscores the need for a multidisciplinary approach and increased outpatient support to address the complex needs of elderly patients with cirrhosis and ascites.