Role of spot urine analyses in patients with cirrhosis and ascites as the single first decompensation event

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INTRODUCTION AND OBJECTIVES: Ascites is the most frequent complication in patients with cirrhosis. Although guidelines propose diuretic treatment monitoring through measuring spot urine sodium, data on its application in clinical care as well as its independent prognostic information are surprisingly scarce. We therefore aimed to evaluate the role of spot urine parameters in patients with cirrhosis and ascites. PATIENTS AND METHODS: We analysed patients managed at the Medical University of Vienna between 2011 and 2024. Data on urine spot analyses were obtained within 30 days of first ascites development and longitudinally thereafter. The prognostic implication for predicting recurrent ascites within 180 days was evaluated. RESULTS: One-hundred and ten patients (61% male, main aetiology alcohol-related liver disease in 61%) were included. Median spot urine sodium was significantly different according to ascites severity and diuretic therapy (grade II + diuretics: 119.0 vs. grade III + diuretics: 54.5 mmol/L; grade II + no diuretics: 60.0 vs. grade III + no diuretics: 16.0 mmol/L). However, neither baseline nor longitudinal spot urine sodium provided independent prognostic information for the development of recurrent ascites within 180 days after adjustment for liver disease severity. Similarly, the spot urine sodium/potassium ratio, analysed continuously or using established cut-offs, was not independently associated with recurrent ascites. These findings remained consistent in sensitivity analyses considering recurrent ascites within 90 days and after accounting for diuretic therapy. CONCLUSIONS: Spot urine analyses around index ascites decompensation were not associated with the development of recurrent ascites in the current study.

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