Sodium-glucose cotransporter 2(SGLT2)inhibitors,including empagliflozin,dapagliflozin,and sotagliflozin,have shown promising effects beyond glycemic control,notably improving sodium and fluid retention in heart failur...Sodium-glucose cotransporter 2(SGLT2)inhibitors,including empagliflozin,dapagliflozin,and sotagliflozin,have shown promising effects beyond glycemic control,notably improving sodium and fluid retention in heart failure.1 Ascites represents a challenging clinical issue frequently encountered in the decompensated phase of cirrhosis,sometimes becoming resistant to conventional diuretic therapies such as loop diuretics and mineralocorticoid receptor antagonists.Refractory ascites is associated with poor prognosis and often leads to life-threatening complications such as spontaneous bacterial peritonitis.2 In cirrhosis,refractory ascites results from severe portal hypertension and splanchnic vasodilation,with consequent neurohormonal(RAAS)overactivation and extreme renal sodium retention.Given the shared pathophysiological mechanisms between advanced heart failure and cirrhosis,3 it has been hypothesized that certain heart failure therapies may be repurposed for the management of refractory ascites in cirrhosis.4 Among them,SGLT2 inhibitors represent a particularly promising class of agents that may offer therapeutic benefits to cirrhotic patients with ascites.Here,we present a case of decompensated cirrhosis in which treatment with empagliflozin completely resolved concomitant refractory ascites and pleural effusion,with sustained improvement in urinary sodium excretion.展开更多
基金supported by Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support(ZLRK202533)High-Level Public Health Technology Talent Project(2022-2-005).
文摘Sodium-glucose cotransporter 2(SGLT2)inhibitors,including empagliflozin,dapagliflozin,and sotagliflozin,have shown promising effects beyond glycemic control,notably improving sodium and fluid retention in heart failure.1 Ascites represents a challenging clinical issue frequently encountered in the decompensated phase of cirrhosis,sometimes becoming resistant to conventional diuretic therapies such as loop diuretics and mineralocorticoid receptor antagonists.Refractory ascites is associated with poor prognosis and often leads to life-threatening complications such as spontaneous bacterial peritonitis.2 In cirrhosis,refractory ascites results from severe portal hypertension and splanchnic vasodilation,with consequent neurohormonal(RAAS)overactivation and extreme renal sodium retention.Given the shared pathophysiological mechanisms between advanced heart failure and cirrhosis,3 it has been hypothesized that certain heart failure therapies may be repurposed for the management of refractory ascites in cirrhosis.4 Among them,SGLT2 inhibitors represent a particularly promising class of agents that may offer therapeutic benefits to cirrhotic patients with ascites.Here,we present a case of decompensated cirrhosis in which treatment with empagliflozin completely resolved concomitant refractory ascites and pleural effusion,with sustained improvement in urinary sodium excretion.
