A simple nomogram identifies patients with refractory ascites with worse outcome after transjugular intrahepatic portosystemic shunt.

Publisher: Lippincott Williams And Wilkins Country of Publication: England NLM ID: 9000874 Publication Model: Print Cited Medium: Internet ISSN: 1473-5687 (Electronic) Linking ISSN: 0954691X NLM ISO Abbreviation: Eur J Gastroenterol Hepatol Subsets: MEDLINE

Publication: London : Lippincott Williams And Wilkins
Original Publication: [London, UK ; Philadelphia, PA, USA] : Current Science, c1989-

Hepatic Encephalopathy*/diagnosis ; Hepatic Encephalopathy*/etiology ; Portasystemic Shunt, Transjugular Intrahepatic*/adverse effects; Ascites/diagnosis ; Ascites/etiology ; Creatinine ; Humans ; Liver Cirrhosis ; Nomograms ; Retrospective Studies ; Sodium ; Treatment Outcome

Objectives: Transjugular intrahepatic portosystemic shunt (TIPS) is increasingly used in the management of refractory ascites. Controversy exists regarding the predictive factors of unfavorable outcomes, useful for patient selection. The primary aim was to identify predictive factors of 1-year survival or recurrent severe hepatic encephalopathy in patients with cirrhosis undergoing covered TIPS for refractory ascites. The secondary aim was overall survival.
Methods: Observational, retrospective, multicentric study, that included all cirrhotic patients treated with covered-TIPS for refractory ascites since 2001. Demographic, clinical, laboratory and hemodynamic data were collected at baseline and consecutively until dead, liver transplant or end of follow-up. The Cox model was used to identify predictive factors of overall survival. A Fine-Gray competing risk regression model was used to identify predictive factors of 1-year mortality or recurrent hepatic encephalopathy. A predictive nomogram was created based on those factors.
Results: In total 159 patients were included. Predictive factors of survival or recurrent severe encephalopathy were renal dysfunction [hazard ratio, 2.12 (95% CI, 1.11-4.04); P = 0.022], albumin [hazard ratio, 0.58 (95% CI, 0.34-0.97); P = 0.036], serum sodium [hazard ratio, 0.94 (95% CI, 0.89-0.98); P = 0.008] and international normalized ratio [hazard ratio 4.27 (95% CI, 1.41-12.88); P = 0.010]. In the competing risk analysis, predictive factors of 1-year mortality/recurrent severe encephalopathy in multivariate analysis were age [sub-distribution hazard ratio (sHR) 1.05 (95% CI, 1.02-1.09); P = 0.001], creatinine [sHR 1.55 (95% CI, 1.23-1.96); P = 0.001] and serum sodium [sHR 0.94 (95% CI, 0.90-0.99); P = 0.011] at baseline.
Conclusions: Age, creatinine and sodium baseline levels strongly influence 1-year survival/recurrent severe hepatic encephalopathy in patients with cirrhosis undergoing covered TIPS for refractory ascites. A simple nomogram accurately and easily identifies those patients with worse prognosis.
(Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Arroyo V, Ginès P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996; 23:164–176.
Runyon BA; AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49:2087–2107.
Salerno F, Guevara M, Bernardi M, Moreau R, Wong F, Angeli P, et al. Refractory ascites: pathogenesis, definition and therapy of a severe complication in patients with cirrhosis. Liver Int 2010; 30:937–947.
Moreau R, Delègue P, Pessione F, Hillaire S, Durand F, Lebrec D, Valla DC. Clinical characteristics and outcome of patients with cirrhosis and refractory ascites. Liver Int 2004; 24:457–464.
Boyer TD, Haskal ZJ; American Association for the Study of Liver Diseases. The role of Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the management of portal hypertension: update 2009. Hepatology 2010; 51:306.
Lebrec D, Giuily N, Hadengue A, Vilgrain V, Moreau R, Poynard T, et al. Transjugular intrahepatic portosystemic shunts: comparison with paracentesis in patients with cirrhosis and refractory ascites: a randomized trial. French group of clinicians and a group of biologists. J Hepatol 1996; 25:135–144.
Rössle M, Ochs A, Gülberg V, Siegerstetter V, Holl J, Deibert P, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 2000; 342:1701–1707.
Ginès P, Uriz J, Calahorra B, Garcia-Tsao G, Kamath PS, Del Arbol LR, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis. Gastroenterology 2002; 123:1839–1847.
Sanyal AJ, Genning C, Reddy KR, Wong F, Kowdley KV, Benner K, McCashland T; North American Study for the Treatment of Refractory Ascites Group. The North American Study for the treatment of refractory ascites. Gastroenterology 2003;124:634–641.
Salerno F, Merli M, Riggio O, Cazzaniga M, Valeriano V, Pozzi M, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Hepatology 2004; 40:629–635.
Narahara Y, Kanazawa H, Fukuda T, Matsushita Y, Harimoto H, Kidokoro H, et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol 2011; 46:78–85.
D’Amico G, Luca A, Morabito A, Miraglia R, D’Amico M. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Gastroenterology 2005; 129:1282–1293.
Deltenre P, Mathurin P, Dharancy S, Moreau R, Bulois P, Henrion J, et al. Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis. Liver Int 2005; 25:349–356.
Albillos A, Bañares R, González M, Catalina MV, Molinero LM. A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites. J Hepatol 2005; 43:990–996.
Salerno F, Cammà C, Enea M, Rössle M, Wong F. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology 2007; 133:825–834.
Chen RP, Zhu Ge XJ, Huang ZM, Ye XH, Hu CY, Lu GR, et al. Prophylactic use of transjugular intrahepatic portosystemic shunt aids in the treatment of refractory ascites: metaregression and trial sequential meta-analysis. J Clin Gastroenterol 2014; 48:290–299.
Perarnau JM, Le Gouge A, Nicolas C, d’Alteroche L, Borentain P, Saliba F, et al.; STIC-TIPS group. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol 2014; 60:962–968.
Bureau C, Thabut D, Oberti F, Dharancy S, Carbonell N, Bouvier A, et al. Transjugular intrahepatic portosystemic shunts with covered stents increase transplant-free survival of patients with cirrhosis and recurrent ascites. Gastroenterology 2017; 152:157–163.
Bercu ZL, Fischman AM, Kim E, Nowakowski FS, Patel RS, Schiano TD, et al. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts. AJR Am J Roentgenol 2015; 204:654–661.
Bucsics T, Hoffman S, Grünberger J, Schoder M, Matzek W, Stadlmann A, et al. ePTFE-TIPS vs repetitive LVP plus albumin for the treatment of refractory ascites in patients with cirrhosis. Liver Int 2018; 38:1036–1044.
Hamel B, Guillaud O, Roman S, Vallin M, Pilleul F, Valette PJ, et al. Prognostic factors in patients with refractory ascites treated by transjugular intrahepatic porto-systemic shunt: from the liver to the kidney. Dig Liver Dis 2014; 46:1001–1007.
Bureau C, Métivier S, D’Amico M, Péron JM, Otal P, Pagan JC, et al. Serum bilirubin and platelet count: a simple predictive model for survival in patients with refractory ascites treated by TIPS. J Hepatol 2011; 54:901–907.
Cazzaniga M, Salerno F, Pagnozzi G, Dionigi E, Visentin S, Cirello I, et al. Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut 2007; 56:869–875.
Tan HK, James PD, Sniderman KW, Wong F. Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion. J Gastroenterol Hepatol 2015; 30:389–395.
Lerrigo R, Beste LA, Leipertz SL, Green PK, Lok AS, Kogut MJ, Ioannou GN. Characteristics and outcomes of transjugular intrahepatic portosystemic shunt recipients in the VA Healthcare System. Eur J Gastroenterol Hepatol 2016; 28:667–675.
Casadaban LC, Parvinian A, Minocha J, Lakhoo J, Grant CW, Ray CE Jr, et al. Clearing the confusion over hepatic encephalopathy after TIPS creation: incidence, prognostic factors, and clinical outcomes. Dig Dis Sci 2015; 60:1059–1066.
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60:715–735.
Lodato F, Berzigotti A, Lisotti A, Azzaroli F, Mosconi C, Giampalma E, et al. Transjugular intrahepatic portosystemic shunt placement for refractory ascites: a single-centre experience. Scand J Gastroenterol 2012; 47:1494–1500.
Trebicka J, Krag A, Gansweid S, Schiedermaier P, Strunk HM, Fimmers R, et al. Soluble TNF-alpha-receptors I are prognostic markers in TIPS-treated patients with cirrhosis and portal hypertension. PLoS One 2013; 8:e83341.
Jansen C, Eischeid H, Goertzen J, Schierwagen R, Anadol E, Strassburg CP, et al. The role of miRNA-34a as a prognostic biomarker for cirrhotic patients with portal hypertension receiving TIPS. PLoS One 2014; 9:e103779.
Maleux G, Perez-Gutierrez NA, Evrard S, Mroue A, Le Moine O, Laleman W, Nevens F. Covered stents are better than uncovered stents for transjugular intrahepatic portosystemic shunts in cirrhotic patients with refractory ascites: a retrospective cohort study. Acta Gastroenterol Belg 2010; 73:336–341.
Noordzij M, Leffondré K, van Stralen KJ, Zoccali C, Dekker FW, Jager KJ. When do we need competing risks methods for survival analysis in nephrology? Nephrol Dial Transplant 2013; 28:2670–2677.

9NEZ333N27 (Sodium)
AYI8EX34EU (Creatinine)

Date Created: 20220120 Date Completed: 20220411 Latest Revision: 20220411

20221213

10.1097/MEG.0000000000002179

35048651