Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) is one of the main treatment options in patients with decompensated liver cirrhosis but is still associated with partly severe complications. For adequate patient selection, prognostic parameters are of crucial importance. The liver maximum capacity (LiMAx) breath test measures enzymatic liver function and could potentially represent an efficient prognostic marker. We therefore aimed to assess the role of LiMAx in predicting survival of TIPS patients in a prospective analysis. LiMAx was performed for patients who underwent TIPS implantation between October 2016 and February 2018. Associations with transplant-free survival after 24 weeks were assessed by logistic regression. A total number of 30 patients were included, of whom seven received liver transplantation (N = 2) or died (N = 5) during follow-up. LiMAx values after (P = 0.01, OR = 1.24, 95% CI = 1.04–1.47) and before (P = 0.03, OR 1.21, 95% CI = 1.02–1.43) TIPS implantation and MELD score (P = 0.03, OR = 0.79, 95% CI = 0.63–0.98) were significantly associated with transplant-free survival according to univariate logistic regression. In AUROC analysis, LiMAx at day one after TIPS (sensitivity 85.7%, specificity 78.3%, AUROC 0.85, cut-off ≤ 165 µg/kg/h), LiMAx value at the day before TIPS (sensitivity 100%, specificity 73.9%, AUROC 0.82, cut-off ≤ 205 µg/kg/h) and MELD score (sensitivity 71.4%, specificity 73.9%, AUROC 0.82, cut-off ≥ 15) had the highest prognostic accuracy. LiMAx values prior and after TIPS procedure seem to be good prognostic parameters regarding prediction of transplant-free survival of patients undergoing TIPS implantation.
Highlights
PBC Primary biliary cholangitis AIH Autoimmune hepatitis ROC Receiver operating characteristic AST Aspartate aminotransferase ALT Alanine aminotransferase INR International normalized ratio NPV Negative predictive value PPV Positive predictive value
Implantation of transjugular intrahepatic portosystemic shunt (TIPS) is associated with different complications, such as occurrence of cardiac d ecompensation14, hepatic encephalopathy (HE)15–18 or impairment of liver function19–21, which can even lead to subsequent liver failure, being the most important of them
Two patients died after severe pneumonia, one showed decompensation after spontaneous bacterial peritonitis, and the other two patients developed rapid reduction of liver function and multiorgan failure without verification of a specific cause, presumably due to reduced hepatic reserve after TIPS implantation
Summary
PBC Primary biliary cholangitis AIH Autoimmune hepatitis ROC Receiver operating characteristic AST Aspartate aminotransferase ALT Alanine aminotransferase INR International normalized ratio NPV Negative predictive value PPV Positive predictive value. Implantation of TIPS is associated with different complications, such as occurrence of cardiac d ecompensation, hepatic encephalopathy (HE) or impairment of liver function, which can even lead to subsequent liver failure, being the most important of them. For these reasons, an adequate selection of patients receiving TIPS is of crucial importance. The liver maximum capacity (LiMAx) breath test is a novel non-invasive quantitative test to measure enzymatic liver function by determining hepatic metabolization of 13C-labeled methacetin by cytochrome P450 1A2 and was initially evaluated to assess operability of patients undergoing hepatic surgery. It was successfully evaluated for other clinical situations, e. g. estimation of survival of patients with acute liver failure or liver transplant (LT) c andidates and for prediction of hepatic disease severity/grade of liver fibrosis
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