Abstract
Objectives Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications. Little is known about the ability of spleen stiffness (SS) for predicting the survival of cirrhotic patients undergoing TIPS. This study is to evaluate the influence of SS detected by point shear wave elastography (pSWE) in predicting survival after TIPS. Methods This retrospective cohort study screened consecutive patients who underwent TIPS and reliable pSWE measurement between October 2014 and September 2017 from our prospectively maintained database. SS values were measured before TIPS. The primary endpoint was the overall survival after TIPS. The Cox regression analysis model was used for univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to calculate the sensitivity, specificity, and positive and negative predictive values. Results A total of 89 patients were involved in the final analysis. 24 patients (27.0%) died during a median follow-up time of 31 m. Multivariable Cox regression analysis confirmed that higher SS value (P < 0.001), LS value (P = 0.008), diameter of shunt (P = 0.001), and older age (P < 0.001) were independent prognostic factors of survival after TIPS. The risk of death rose 57.440-fold for each SS unit (m/s) increase. SS was also correlated with liver failure after TIPS. ROC analysis showed that the best SS cutoff value was 3.60 m/s for predicting survival, with a sensitivity of 54.2% and specificity of 90.8%. Conclusions The SS value determined by pSWE in cirrhotic patients was an independent predictive factor for survival after TIPS.
Highlights
Portal hypertension caused by liver cirrhosis often leads to gastroesophageal variceal bleeding and ascites, which remains a challenging task in clinical practice
Different clinical characteristics in patients often result in a significant difference in prognosis after transjugular intrahepatic portosystemic shunt (TIPS); that is, some patients cannot benefit from TIPS in survival [2]
Liver stiffness (LS) and spleen stiffness (SS) have been proved to be correlated with hepatic venous pressure gradient in compensated and decompensated cirrhotic patients by many studies [3,4,5,6], while few works are aimed at demonstrating the association between LS/SS and survival, especially in patients undergoing TIPS [7]
Summary
Portal hypertension caused by liver cirrhosis often leads to gastroesophageal variceal bleeding and ascites, which remains a challenging task in clinical practice. Transjugular intrahepatic portosystemic shunt (TIPS) has been an effective procedure to manage variceal bleeding and refractory ascites by reducing the portal pressure in patients with advanced cirrhosis. TIPS is often associated with a relatively high risk of postprocedure complications, such as liver failure and hepatic encephalopathy, and sometimes with high mortality [1]. Liver stiffness (LS) and spleen stiffness (SS) have been proved to be correlated with hepatic venous pressure gradient in compensated and decompensated cirrhotic patients by many studies [3,4,5,6], while few works are aimed at demonstrating the association between LS/SS and survival, especially in patients undergoing TIPS [7]. Lee et al demonstrated that LS detected using MRE was a predictive factor for the development of decompensation and overall
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