Ascites is one of the most frequent and visible complications of liver cirrhosis. It is characterized by the pathological accumulation of fluid in the peritoneal cavity, leading to abdominal distension, respiratory difficulty, and pain. Beyond its physical impact, ascites marks a clinical turning point: it indicates that liver disease has progressed from a compensated to a decompensated state, significantly increasing the risk of mortality.
According to various studies, around 50% of patients with cirrhosis will develop ascites within 10 years of diagnosis (Wang et al., 2023). However, figures vary between regions and depend on factors such as the underlying causes of liver disease, lifestyle patterns, and access to healthcare.
Below is a comparative analysis between Colombia and the United States, highlighting the main statistics, proportions, and trends related to this condition.
General outlook in the United States
In the United States, data on liver disease is extensively documented. According to the Centers for Disease Control and Prevention (CDC), approximately 4.5 million adults (1.8% of the population) live with a diagnosed liver disease (CDC, 2018). Most cases of ascites result from advanced cirrhosis, which may stem from excessive alcohol consumption, viral hepatitis, or nonalcoholic fatty liver disease (NAFLD).
A recent study by Tapper et al. (2023) analyzed a cohort of more than 63,000 patients with cirrhosis enrolled in the Medicare system. The results showed that cumulative incidence of ascites was 5.1% at one year, 9.5% at three years, and 10.7% at five years. In addition, a small percentage (between 1% and 2.4%) required therapeutic paracentesis, meaning drainage of the fluid to alleviate symptoms. The same study found that patients who developed ascites had a 27-fold higher likelihood of death compared with patients with compensated cirrhosis.
These data reflect not only the severity of the condition but also its substantial economic impact. Treating ascites—through repeated hospitalizations, invasive procedures, and medications such as diuretics or albumin—represents a significant financial burden on the U.S. healthcare system.
Situation in Colombia
Although Colombia has fewer large-scale population studies, hospital data and available clinical reports clearly indicate the importance of ascites as one of the main causes of hospitalization for decompensated cirrhosis.
A recent study by Vélez et al. (2023), which analyzed Colombian patients hospitalized between 2014 and 2020, found that ascites was present in 45.6% of episodes of hepatic decompensation. In other words, nearly half of cirrhosis-related hospitalizations in the country are directly linked to this complication.
Additionally, Garzón Olarte (2004), in a study conducted in Bogotá, reported that up to 50% of patients with compensated cirrhosis developed ascites at some point in the progression of their disease. These findings—separated by nearly two decades—show a consistent trend: ascites remains the most common manifestation of hepatic decompensation in Colombia.
It has also been noted that most affected patients belong to middle and low socioeconomic groups, which may be associated with limited access to specialized care, delayed diagnosis, and challenges in maintaining adequate treatment. This pattern mirrors what is observed across many Latin American countries, where chronic liver disease continues to be underdiagnosed and underreported.
Comparison of figures between both countries
| Indicator | United States | Colombia |
|---|---|---|
| Adults with diagnosed liver disease | 4.5 million (CDC, 2018) | Hundreds of thousands according to administrative records (Vélez et al., 2023) |
| Risk of developing ascites in cirrhosis | 50–60% at 10 years (Wang et al., 2023) | 45–50% of decompensation-related hospitalizations (Vélez et al., 2023; Garzón Olarte, 2004) |
| Cumulative incidence of ascites | 5.1% (1 year), 9.5% (3 years), 10.7% (5 years) (Tapper et al., 2023) | No large-scale longitudinal studies available |
| Main causes | Alcohol-related cirrhosis, hepatitis C, NAFLD | Alcohol-related cirrhosis and hepatitis B and C |
| Percentage of ascites due to malignancy | 10% of cases (Khan et al., 2017) | Not specifically reported |
In both countries, nearly half of patients with cirrhosis develop ascites, underscoring its role as a key indicator of hepatic decompensation.
Clinical and social relevance
The onset of ascites is not only a marker of poor clinical prognosis but also has direct repercussions on patients’ quality of life and family dynamics. Physical symptoms—such as increased abdominal volume, dyspnea, or constant heaviness—combine with emotional and social burdens.
Moreover, frequent hospitalizations and treatment expenses can be financially devastating, especially in healthcare systems with limited coverage.
From a public health perspective, both Colombia and the United States face a growing challenge: the rise of nonalcoholic fatty liver disease, linked to sedentary lifestyles and obesity, which is emerging as the future leading cause of cirrhosis—and therefore of ascites (Wang et al., 2023). This suggests a potentially significant increase in cases in the coming decades unless prevention and early diagnosis strategies are strengthened.
Conclusions
The data clearly show that ascites is a highly prevalent and costly complication in both the United States and Colombia.
In the former, records indicate that more than 4 million adults are at risk of developing it, with high mortality and hospitalization rates. In the Colombian context, although epidemiological research is more limited, clinical studies indicate that nearly half of hospitalized cirrhosis patients present ascites.
Beyond the numbers, ascites represents a challenge that spans medical and social dimensions: it deteriorates quality of life, increases household expenses, and places pressure on hospital services. Addressing this condition requires preventive liver health policies, timely diagnosis, and comprehensive follow-up for patients with cirrhosis, both in Colombia and worldwide.
References
Centers for Disease Control and Prevention. (2018). FastStats – Chronic Liver Disease and Cirrhosis.
Garzón Olarte, M. A. (2004). Ascitis cirrótica y sus complicaciones en un hospital de Bogotá, D.C. Revista Colombiana de Gastroenterología, 19(2), 62–70.
Khan, S. A., et al. (2017). Malignant ascites-associated U.S. hospitalizations: Epidemiology and outcomes. Journal of Clinical Gastroenterology, 51(8), 720–725.
Tapper, E. B., et al. (2023). The incidence of, risk factors for, and outcomes after ascites in a cohort of U.S. Medicare enrollees with cirrhosis. PLOS ONE, 18(4), e10905652.
Vélez, J. L., et al. (2023). Caracterización de pacientes con cirrosis agudamente descompensada en Colombia entre 2014–2020. Revista Colombiana de Gastroenterología, 38(1), 11–19.
Wang, H., et al. (2023). Ascites complications, risk factors and outcomes in patients with decompensated cirrhosis. BMC Gastroenterology, 25(40).
