Design: Systematic review and meta-analysis
Population: 16 studies, 1,040 patients with refractory ascites due to cirrhosis
Primary outcome: Patient- and caregiver-reported outcomes
Effect: SF-36 social functioning −18.8 (95% CI −30.2 to −7.3) vs stable cirrhosis

This systematic review identified 16 studies of patient-reported outcomes in refractory ascites due to advanced chronic liver disease, covering 1,040 patients and only 47 caregivers.

Compared with stable cirrhosis outpatients, patients with refractory ascites scored lower in social functioning (mean difference −18.8 on SF-36), mental health (−17.9) and physical functioning (−13.6), and on liver-specific measures of abdominal symptoms, activity, worry and emotional function. Disease-specific tools picked up more impairment than generic ones, but only one symptom questionnaire had been validated in this group.

Symptoms and quality of life are rarely measured routinely in refractory ascites, yet they should shape decisions about paracentesis schedules, TIPS, transplant referral and palliative care.

Ask patients with refractory ascites about breathlessness, mobility, sleep and mood.
Use a disease-specific questionnaire where possible to track symptoms over time.
Ask about the carer's burden and support at home.
Discuss palliative care alongside paracentesis, TIPS or transplant evaluation.

Why it matters

The burden of refractory ascites goes far beyond the volume drained.

The statistics, in plain English

Mean differences of 14 to 19 points on SF-36 domains are large and clinically meaningful. Pooled estimates came from only three or four studies each, so they are imprecise.