Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) placement is effective in the treatment of complications of portal hypertension. This study evaluated the predictors of mortality in a group of cirrhotic patients with advanced liver disease after placement of TIPS. Methods:...

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Published in:	Gastroenterology (New York, N.Y. 1943) Vol. 118; no. 1; pp. 138 - 144
Main Authors:	Chalasani, Naga, Clark ‡, W.Scott, Martin §, L.G., Kamean ∥, Jeffrie, Khan, M.Abdul, Patel ¶, Nilesh H., Boyer ∥, Thomas D.
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 2000 Elsevier
Subjects:	Adult Ascites - surgery Biological and medical sciences Cause of Death Esophageal and Gastric Varices - surgery Female Gastroenterology. Liver. Pancreas. Abdomen Gastrointestinal Hemorrhage - surgery Humans Hydrothorax - surgery Hypertension, Portal - complications Hypertension, Portal - surgery Liver Cirrhosis - complications Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Other diseases. Semiology Portasystemic Shunt, Transjugular Intrahepatic Recurrence Retrospective Studies RR CT HR GEC CI TIPS Human Cirrhosis Treatment Liver Mortality Risk factor Digestive diseases Hepatic disease Epidemiology Transjugular intrahepatic portosystemic shunt
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Summary:	Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) placement is effective in the treatment of complications of portal hypertension. This study evaluated the predictors of mortality in a group of cirrhotic patients with advanced liver disease after placement of TIPS. Methods: A retrospective analysis of all patients undergoing TIPS placement over a 2 ½-year period was undertaken.A retrospective analysis of all patients undergoing TIPS placement over a 2 ½-year period was undertaken. Results: Fifty-six patients had TIPS placement for variceal hemorrhage, 49 for refractory ascites, and 24 for hepatic hydrothorax (total, 129). Of 21 variables available before TIPS placement, variceal hemorrhage requiring emergent TIPS placement (relative risk [RR], 37.5;95% confidence interval [CI], 5.4-259) and bilirubin concentration > 3.0 mg/dL (RR, 5.4;95% CI, 1.4-10.2) were independent predictors of 30-day mortality. Variceal hemorrhage requiring emergent TIPS placement (hazard ratio [HR], 5.1, 95% CI, 2.2-9.1), alanine aminotransferase level > 100 IU/L (HR, 2.5;95% CI, 1.2-5.5), bilirubin level > 3.0 mg/dL (HR, 2.6;95% CI, 1.1-4.6), and pre-TIPS encephalopathy unrelated to bleeding (HR, 2.2;95% CI, 1.2-4.8) independently predicted death during the follow-up period. A model was developed that separated the patients into 3 groups with significantly different survival rates. Conclusions: A clinical index consisting of 4 pre-TIPS variables can reliably predict outcome after TIPS. GASTROENTEROLOGY 2000;118:138-144
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0016-5085 1528-0012
DOI:	10.1016/S0016-5085(00)70422-7