Abstract:
BACKGROUND:The presence of refractory ascites is a common indication for transjugular intrahepatic portosystemic shunt (TIPS). Different models have been proposed for the prediction of survival after TIPS. The aim of this study was to evaluate the predictive factors associated with patients' survival after TIPS placement for refractory ascites. METHODS:Data from all consecutive patients undergoing TIPS placement in our center for refractory ascites between February 2003 and January 2008 were prospectively recorded. RESULTS:Seventy-three patients (52M/21F; 57 ± 10 years) met the inclusion criteria; mean follow-up was 17 ± 2 months. Mean MELD value, before TIPS placement, was 15.7 ± 5.3. TIPS placement led to an effective resolution of refractory ascites in 54% of patients (n = 40) with no significant increase in severe portosystemic encephalopathy. The 1-year survival rate observed was 65.7%, while the overall mortality was 23.3% (n = 17) with a mean survival of 17 ± 14 months. MELD score (B = 0.161, p = 0.042), basal AST (B = 0.020, p = 0.090), and pre-TIPS HVPG (B = 0.016, p = 0.093) were independent predictors of overall mortality, while MELD (B = 0.419, p = 0.018) and HVPG (B = 0.223, p = 0.060) independently predicted 1-year survival. ROC curves identified MELD ≥ 19 and HVPG ≥ 25 mmHg as the best cut-off points for the prediction of 1-year mortality. CONCLUSIONS:TIPS is an effective treatment for refractory ascites in cirrhotic patients, leading to an effective ascites control in more than half patients. Improvement in patients' selection criteria could lead to better outcome and survival after this procedure. Liver function (MELD), presence of active necroinflammation (AST), and portal hypertension (HVPG) are independent predictors of patients' outcome after TIPS.
journal_name
Scand J Gastroenteroljournal_title
Scandinavian journal of gastroenterologyauthors
Lodato F,Berzigotti A,Lisotti A,Azzaroli F,Mosconi C,Giampalma E,Renzulli M,Cappelli A,Buonfiglioli F,Calvanese C,Zoli M,Golfieri R,Mazzella Gdoi
10.3109/00365521.2012.703239subject
Has Abstractpub_date
2012-12-01 00:00:00pages
1494-500issue
12eissn
0036-5521issn
1502-7708journal_volume
47pub_type
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journal_title:Scandinavian journal of gastroenterology
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Scandinavian journal of gastroenterology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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pub_type: 临床试验,杂志文章,随机对照试验
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