Abstract
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure for hepatic decompression and lowering of portal hypertension. The procedure is performed angiographically by inserting a metal stent between the hepatic and portal vein. Improved techniques and the expanding indications of TIPS throughout the years have made it more common. Consequently, a better prediction accuracy of its outcomes and complications is warranted. The aims of this study were to present real-life experience with the TIPS procedure and to identify novel risk factors for shortterm complications and mortality. Methods and findings: We conducted an observational, retrospective study of all patients who underwent a TIPS procedure from 2005-2017 in a single tertiary center. Data collected from the medical records included demographics, anthropometrics, co-morbidities, biochemical tests, indications and short-term (≤ 90 days) complications. Binary logistic regression analysis was conducted to determine risk factors for 90-day mortality. Results: A total of 101 patients (54% males and mean age of 55.9 ± 15.7 years) underwent technically successful TIPS insertion. The most common complications were hepatic encephalopathy (43.6%, n=44) and hepatic decompensation (17.8%, n=18). The incidence of 90-day mortality was 21.8% (n=22). Multivariate analysis revealed that older age (OR=1.061, 95% CI: 1.006-1.119), hypertension (OR=6.193, 95% CI: 1.666-23.024) and high Model for End-Stage Liver Disease (MELD) score (OR=1.167, 95% CI: 1.017-1.329) were independent and significant predictors of early post-TIPS mortality. Conclusions: Older age, hypertension and high MELD score are independent predictors of early mortality postTIPS. We recommend considering these risk factors when selecting patients for TIPS insertion.
Highlights
Portal hypertension is common in patients with cirrhosis [1], its clinical manifestations include variceal bleeding, ascites, splenomegaly with hypersplenism as well as other less common complications such as hepatic hydrothorax, hepatorenal syndrome and others [2]
We reviewed medical records to determine age, gender, Body Mass Index (BMI)) and clinical data including co-morbidities, underlying causes of cirrhosis and portal hypertension complications
We analyzed a cohort of 101 patients with portal hypertension who underwent the Transjugular intrahepatic portosystemic shunt (TIPS) procedure in a single center over a period of 12 years
Summary
Portal hypertension is common in patients with cirrhosis [1], its clinical manifestations include variceal bleeding, ascites, splenomegaly with hypersplenism as well as other less common complications such as hepatic hydrothorax, hepatorenal syndrome and others [2]. Transjugular intrahepatic portosystemic shunt (TIPS) is a non-surgical interventional radiology procedure for hepatic decompression and lowering of portal hypertension. TIPS reduces portal pressure by creating an artificial shunt between the portal vein and hepatic vein branches, via insertion of a metal stent [3]. Other indications include hepatic hydrothorax, hepatorenal syndrome, Budd-Chiari syndrome and preoperative TIPS for cirrhotic patients undergoing abdominal and pelvic surgery [5]. Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure for hepatic decompression and lowering of portal hypertension. The procedure is performed angiographically by inserting a metal stent between the hepatic and portal vein. The aims of this study were to present real-life experience with the TIPS procedure and to identify novel risk factors for shortterm complications and mortality
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