Predictors of Re‐bleeding and Mortality Among Patientswith Refractory Variceal Bleeding Undergoing Salvage Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Vincenza Calvaruso, Grazia Isgrò, Emmanuel Tsochatzis, Angela Alibrandi, Sergio Maimone, Elias Xirouchakis, Vincenza Calvaruso, Roberto Filomia, Andrew K. Burroughs, Francesca Saffioti, Sergio Maimone, David Patch, Gian Piero Guerrini

Risultato della ricerca: Articlepeer review

11 Citazioni (Scopus)

Abstract

AbstractBackground Transjugular intrahepatic portosystemic shunt (TIPS) has proven clinical efcacy as rescue therapy for cirrhoticpatients with acute portal hypertensive bleeding who fail endoscopic treatment.Aims To investigate predictive factors of 6-week and 1-year mortality in patients undergoing salvage TIPS for refractoryportal hypertensive bleeding.Methods A total of 144 consecutive patients were retrospectively evaluated. Three logistic regression multivariate modelswere estimated to individualize prognostic factors for 6-week and 12-month mortality. Log-rank test was used to evaluatesurvival according to Child–Pugh classes and Bureau’s criteria.Results Mean age 51±10 years, 66% male, mean MELD 18.5±8.3, Child–Pugh A/B/C 8%/38%/54%. TIPS failure occurredin 23(16%) patients and was associated with pre-TIPS portal pressure gradient and pre-TIPS intensive care unit stay. Six-weekand 12-month mortality was 36% and 42%, respectively. Pre-TIPS intensive care unit stay, MELD, and Child–Pugh scorewere independently associated with mortality at 6 weeks. Independent predictors of mortality at 12 months were pre-TIPSintensive care unit stay and Child–Pugh score.Conclusions In this large cohort of patients undergoing salvage TIPS, MELD and Child–Pugh scores were predictive ofshort- and long-term mortality, respectively. Pre-TIPS intensive care unit stay was independently associated with TIPS failureand mortality at 6 weeks and 12 months. Salvage TIPS is futile in patients with Child–Pugh score of 14–15.
Lingua originaleEnglish
Numero di pagine11
RivistaDigestive Diseases and Sciences
Stato di pubblicazionePublished - 2018

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

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