Predictive power of portal pressure gradient remeasured shortly after transjugular intrahepatic portosystemic shunt.

Abstract

The portal pressure gradient (PPG) measured at the time of transjugular intrahepatic portosystemic shunt (TIPS) completion (immediate PPG) is easily disturbed by many factors. This study aimed to assess the diagnostic value of PPG remeasured 2-4days after TIPS (delayed PPG) by comparison with immediate PPG. We retrospectively analyzed cirrhotic patients aged 18-75years who received TIPS for preventing variceal rebleeding and pressure measurements at different time points. Of 154 eligible patients, 60 (39.0%), 62 (40.3%), and 32 (20.8%) were categorized into group LL (both immediate and delayed PPG < 12mmHg), LH (immediate PPG < but delayed PPG ≥ 12mmHg) and HH (both immediate and delayed PPG ≥ 12mmHg), respectively. Mean immediate and delayed PPG were 9.2mmHg and 12.8mmHg (p < 0.001). During a median follow-up of 22months, the 1-year probability of variceal rebleeding was significantly lower in groupLL (1.7%) compared to LH (9.8%, absolute risk difference [ARD]: - 8.2%, p = 0.028) and HH (12.6%, ARD: - 11.1%, p = 0.014), but was not significantly different between groups LH and HH (ARD: - 2.9%, p = 0.671). Delayed PPG (p < 0.001) was identified as an independent predictor of variceal rebleeding in multivariable Cox regression analysis. The area under curves of delayed and immediate PPG in predicting variceal rebleeding were 0.837 and 0.693 for all patients (p = 0.031), and 0.936 and 0.694 for patients without shunt dysfunction (p < 0.001). In cirrhotic patients with variceal bleeding, delayed PPG has higher predictive power for variceal rebleeding than immediate PPG.