Prediction of Mortality and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement: Baseline and Longitudinal Body Composition Measurement.

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  • Additional Information
    • Source:
      Publisher: Society of Cardiovascular and Interventional Radiology Country of Publication: United States NLM ID: 9203369 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1535-7732 (Electronic) Linking ISSN: 10510443 NLM ISO Abbreviation: J Vasc Interv Radiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: Reston, Va. : Society of Cardiovascular and Interventional Radiology, c1990-
    • Subject Terms:
      Portasystemic Shunt, Transjugular Intrahepatic*/adverse effects ; Portasystemic Shunt, Transjugular Intrahepatic*/mortality ; Hepatic Encephalopathy*/etiology ; Hepatic Encephalopathy*/mortality ; Hepatic Encephalopathy*/diagnostic imaging ; Hepatic Encephalopathy*/physiopathology ; Predictive Value of Tests* ; Registries* ; Liver Cirrhosis*/mortality ; Liver Cirrhosis*/diagnostic imaging; Humans ; Male ; Female ; Middle Aged ; Risk Factors ; Risk Assessment ; Aged ; Time Factors ; Treatment Outcome ; Adiposity ; Body Composition ; Retrospective Studies ; Tomography, X-Ray Computed ; Case-Control Studies
    • Abstract:
      Purpose: To investigate effects of baseline and early longitudinal body composition changes on mortality and hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).
      Materials and Methods: This is a case-control study with analysis of a TIPS registry (1995-2020) including data from patients with cirrhosis with computed tomography (CT) scans obtained within 1 month before and 3 months after TIPS. Core muscle area (CMA), macroscopic subcutaneous adipose tissue (mSAT), macroscopic visceral adipose tissue (mVAT) area, and muscle adiposity index (MAI) on CT were obtained. Multipredictor Cox proportional hazards models were used to assess the effect of body composition variables on mortality or HE.
      Results: In total, 280 patients (158 men; median age, 57.0 years; median Model for End-stage Liver Disease-sodium [MELD-Na] score, 14.0) were included. Thirty-four patients had post-TIPS imaging. Median baseline CMA was 68.3 cm 2 (interquartile range, 57.7-83.5 cm 2 ). Patients with higher baseline CMA had decreased risks of mortality (hazard ratio [HR]: 0.82; P = .04) and HE (HR: 0.82; P = .009). It improved prediction of mortality over MELD-Na and post-TIPS right atrial pressure alone (confidence interval = 0.729). An increase in CMA (HR: 0.60; P = .043) and mSAT (HR: 0.86; P = .022) or decrease in MAI (HR: 1.50; P = .049) from before to after TIPS was associated with a decreased risk of mortality. An increase in mSAT was associated with an increased risk of HE (HR: 1.11; P = .04).
      Conclusions: CMA on CT scan 1 month before TIPS placement predicts mortality and HE in patients with cirrhosis. Changes in body composition on CT measured 3 months after TIPS placement independently predict mortality and HE.
      (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)
    • Publication Date:
      Date Created: 20240120 Date Completed: 20240425 Latest Revision: 20240425
    • Publication Date:
      20240426
    • Accession Number:
      10.1016/j.jvir.2024.01.012
    • Accession Number:
      38244917