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Kazem Nouri, Johannes Ott, Christian Lenart, Katharina Walch, Regina Promberger, Clemens Tempfer

• \(\textit {Background:}\) To identify predictors of paracentesis in women with severe ovarian hyperstimulation syndrome (OHSS). \(\textit {Methods:}\) In a retrospective cohort study, we assessed patient characteristics and outcome measures of women with severe OHSS Golan grade II/III from 1996 to 2010 using univariate and multivariate analyses with the number of paracenteses as the main outcome. \(\textit {Results:}\) Three hundred ninety four women with OHSS Golan grade II (n = 40) and grade III (n = 354) were included in the study. Paracentesis was performed in 108/394 (27%) of these women. One paracentesis was performed in 63 (16%), 2 paracenteses in 26 (6%), and \(\geq\) 3 paracenteses 19 (5%) women, respectively. No thrombotic or cerebrovascular morbidity occurred. The mortality of the cohort was 0/394 (0%). In a univariate analysis, late onset OHSS (p = 0.02), pregnancy (p < 0.001), human chorionic gonadotropin use (p = 0.02), ovarian diameter (p = 0.006), and elevated serum levels of alanine aminotransferase (p < 0.001), hematocrit (p < 0.001), leucocytes (p < 0.001), thrombocytes (p < 0.001), and uric acid (p < 0.001) were associated with paracentesis. In a multivariate logistic regression analysis, only alanine aminotransferase (OR 1.006; 95% CI 1.001–1.01) and hematocrit (OR 1.16; 95% CI 1.05–1.27) were independently associated with paracentesis. \(\textit {Conclusion:}\) Alanine aminotransferase and hematocrit at initial presentation are independent predictors of paracentesis.