Early Dynamics of Portal Pressure Gradient After TIPS Insertion Predict Mortality

Alimentary Pharmacology & Therapeutics, vol. 61, pp. 1175–1182

Abstract

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) placement leads to a reduction in portal pressure and an improvement in survival in patients with recurrent and refractory ascites and variceal haemorrhage. Prediction of post-TIPS survival is primarily determined by factors identified before the TIPS procedure, as data collected during or after TIPS implantation are limited. The aim of the study was to evaluate the influence of early hemodynamic changes after TIPS placement on survival, in order to refine post TIPS management. METHODS: In this prospective bicentric study, consecutive patients (n = 105) undergoing TIPS placement for ascites or variceal haemorrhage underwent measurement of portal pressure gradient (PPG) immediately at TIPS insertion (PPG0) and 24 h later (PPG24h) and the ΔPPG was calculated from PPG24h and PPG0 (ΔPPG = PPG24h-PPG0). Kaplan-Meier survival analysis and uni- and multivariable regression analyses were conducted to identify survival predictors. RESULTS: Patients with lack of increased ΔPPG exhibited poorer 90-day and 1-year survival compared to patients with increased ΔPPG. This worse survival was independent of The Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, bilirubin levels, creatinine and the Freiburg index of post-TIPS survival (FIPS) > 0.92. Among these patients with poorer outcome, elevated bilirubin (> 25 μmol/L) further distinguished survivors from non-survivors. CONCLUSION: Lack of increased ΔPPG post-TIPS insertion identifies a high-risk patient group with worse survival. We propose incorporating this second PPG measurement and determining ΔPPG into clinical practice to identify these patients early and tailor post-TIPS patient care.

Authors 15

1. Philipp Alexander Reuken

   Jena University Hospital · Friedrich Schiller University Jena

   Affiliation as printed

   Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital Friedrich‐Schiller‐University Jena Germany

   Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

2. Axel Rainer Franz

   Jena University Hospital · Friedrich Schiller University Jena

   Affiliation as printed

   Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital Friedrich‐Schiller‐University Jena Germany

   Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

3. Theresa Hildegard Wirtz Aachen Medical Department III

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Medical Department III University Hospital RWTH Aachen Aachen Germany

   Medical Department III, University Hospital RWTH Aachen, Aachen, Germany

4. Cristina Ripoll

   Jena University Hospital · Friedrich Schiller University Jena

   Affiliation as printed

   Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital Friedrich‐Schiller‐University Jena Germany

   Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

5. René Aschenbach

   Jena University Hospital · Friedrich Schiller University Jena

   Affiliation as printed

   Department of Radiology Jena University Hospital, Friedrich‐Schiller‐University Jena Germany

   Department of Radiology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

6. Ulf Karl-Martin Teichgräber

   Jena University Hospital · Friedrich Schiller University Jena

   Affiliation as printed

   Department of Radiology Jena University Hospital, Friedrich‐Schiller‐University Jena Germany

   Department of Radiology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

7. Maike R. Pollmanns Aachen Medical Department III

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Medical Department III University Hospital RWTH Aachen Aachen Germany

   Medical Department III, University Hospital RWTH Aachen, Aachen, Germany

8. Michael Kiehntopf

   Jena University Hospital · Friedrich Schiller University Jena

   Affiliation as printed

   Institute of Clinical Chemistry and Laboratory Diagnostics Jena University Hospital, Friedrich‐Schiller University Jena Germany

   Institute of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, Friedrich-Schiller University, Jena, Germany

9. Sebastian Keil Aachen Department of Diagnostic and Interventional Radiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology University Hospital RWTH Aachen Aachen Germany

   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany

10. Christiane Katharina Kuhl Aachen Department of Diagnostic and Interventional Radiology

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology University Hospital RWTH Aachen Aachen Germany

    Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany

11. Paul Christian Schulze

    Jena University Hospital · Friedrich Schiller University Jena

    Affiliation as printed

    Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, Jena University Hospital Friedrich‐Schiller‐University Jena Germany

    Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

12. Christian Trautwein Aachen Medical Department III

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Medical Department III University Hospital RWTH Aachen Aachen Germany

    Medical Department III, University Hospital RWTH Aachen, Aachen, Germany

13. Tony Bruns Aachen Medical Department III

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Medical Department III University Hospital RWTH Aachen Aachen Germany

    Medical Department III, University Hospital RWTH Aachen, Aachen, Germany

14. Andreas Stallmach

    Jena University Hospital · Friedrich Schiller University Jena

    Affiliation as printed

    Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital Friedrich‐Schiller‐University Jena Germany

    Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany

15. Alexander Zipprich corresponding

    Jena University Hospital · Friedrich Schiller University Jena

    Affiliation as printed

    Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital Friedrich‐Schiller‐University Jena Germany

    Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany