Prognostic factors in patients with refractory ascites treated by transjugular intrahepatic porto-systemic shunt: From the liver to the kidney

Abstract

BackgroundThe aim of this retrospective study was to evaluate the prognostic value of different scores (including Child–Pugh and Model for End Stage Liver Diseases) in cirrhotic patients treated with transjugular intrahepatic porto-systemic shunt for refractory ascites. MethodsOverall, 111 patients with transjugular intrahepatic porto-systemic shunt insertion between January 1998 and July 2012 were included. ResultsSurvival rates (without transplantation) were 82.0% at 3 months, and 59.4% at 1 year. In addition to standard parameters, a new simple classification based on platelet count and glomerular filtration rate showed strong prognostic ability and could distinguish 3 groups of patients (Log-rank test, p<0.001): a “good-prognosis” group with platelet counts above 125×109L−1 and a glomerular filtration rate above 90mL/min (1-year survival rate 92%), a “poor-prognosis” group with platelet counts below 125×109L−1 and a glomerular filtration rate below 90mL/min (1-year survival rate 34.8%), and an “intermediate-prognosis” group (1-year survival rate 58.2%). Multivariate analysis showed a hazard ratio of 6.34 for the intermediate class and of 12.623 for the high class. ConclusionsA new and simple classification including platelet count and glomerular filtration rate is highly predictive of survival in patients with refractory ascites treated with transjugular intrahepatic porto-systemic shunt and could be used to select patients for this procedure.