Purpose <p>This study aimed to evaluate the utility of peritoneovenous shunt (PVS) placement for refractory ascites (RA) based on preoperative biomarkers.</p> Methods <p>This retrospective cohort study included patients with malignant and cirrhotic RA undergoing PVS placement treated at Sumoto Itsuki Hospital between January 2001 and March 2024. The efficacy of PVSs was defined according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). The usefulness of the prognostic nutritional index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-to-albumin ratio as prognostic indicators for the efficiency of PVS was evaluated.</p> Results <p>In total, 149 consecutive patients (malignant RA, <i>n</i> = 100; cirrhotic RA, <i>n</i> = 49) were included in this study. PVS placement satisfied the efficacy criteria for ascites in 102 (68%) patients in the entire cohort. The estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m² was an independent predictor for the inefficacy of PVSs (odds ratio: 2.82, 95% CI: 1.04–7.73, <i>P</i> = 0.042). Based on receiver operating characteristic curve and multivariate analysis of the entire cohort, NLR ≥ 5.8 was an independent risk factor for death within 1 week after PVS placement (odds ratio: 18.2, 95% CI: 2.07–29.7, <i>P</i> = 0.016).</p> Conclusion <p>PVS placement for RA may be a treatment option when preoperative eGFR is &gt; 30 mL/min/1.73 m² and NLR is &lt; 5.8.</p>