Abstract No. 582 Liver volume as a predictor of 30-day mortality post transjugular intrahepatic portosystemic shunt (TIPS) creation

Abstract

To evaluate liver volume and baseline laboratory values as predictors of 30-day mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. Following IRB approval, a retrospective analysis was performed on all patients who underwent TIPS procedure from January 2016 to August 2018. We systematically reviewed pre-TIPS laboratory values, linear hepatic measurements correlating with liver volume on pre-TIPS cross sectional imaging, and transplantation status. The main outcome variable, 30-day mortality, was also recorded. Statistical analysis was then performed to evaluate the relationship between the predictor and outcome variables. A total of 92 patients successfully underwent TIPS creation during the reviewed period. Of these, 68 had cross sectional imaging (CT/MRI) prior to TIPS placement. The overall 30-day mortality was 14.1% (n = 13), while those with prior cross sectional imaging had a 30-day mortality of 13.2% (n = 9). Smaller linear measurements correlating to liver volume in the post-TIPS mortality group were found to be statistically significant. These included midhepatic point craniocaudad (MHP CC) mean of 7.79 cm (p = 0.007), maximum craniocaudad to liver tip (MAX CC) mean of 13.1 cm (p = 0.001), and midhepatic point anteroposterior (MHP AP) x MHP CC mean of 116.4 cm (p = 0.036). MHP AP alone was not found to be significantly different in the 30-day mortality group. Additionally, lower albumin levels (mean of 2.68, p < 0.0005), increased sodium levels (mean of 140.6, p = 0.044), and elevated INR (mean of 1.69, p = 0.034) were all associated with early 30-day mortality following TIPS placement. No significant difference was found involving creatinine, AST, ALT, total bilirubin, hemoglobin, platelet, and MELD values between the two groups. Measurements representative of smaller liver volumes were strongly associated with increased 30-day mortality after TIPS creation. Additionally, albumin, sodium, and INR values were associated with increased post TIPS 30-day mortality.