Gender-Specific Differences in Early Outcomes After TIPS Placement
Zeitschrift für Gastroenterologie, vol. 64
Abstract
Background Gender-specific differences in outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement remain underexplored. This study aimed to assess differences between female and male patients in clinical characteristics and outcome after TIPS. Methods We analyzed 1359 patients (36% female) from 8 german centers who underwent elective TIPS placement for treatment of refractory ascites or secondary prophylaxis of variceal bleeding. Baseline characteristics, TIPS indications, outcomes within 90 days post-procedure and 3 and 12 month survival were compared by gender. Risk factors for bacterial infections were assessed using a competing risk regression model (Fine & Gray), adjusting for death and liver transplantation. Results Women had lower rates of alcohol-related liver disease (59.9% vs. 68.9%, p<0.001), better FIPS scores (median -0.06 vs. 0.12, p<0.001), and more frequent TIPS for variceal bleeding (27.8% vs. 21.2%, p=0.023). Bacterial infections occurred significantly more often in women within 90 days (18.0% vs. 12.5%, p=0.006), particularly urinary tract infections. No differences were observed for hepatic encephalopathy, ascites persistence, ACLF, or survival. In multivariable analysis, female sex remained an independent risk factor for post-TIPS infection (sHR 1.47, 95% CI 1.11–1.94, p=0.007), alongside age and leukocyte count. Conclusion Gender had no impact on the overall risk of acute decompensation, the occurrence of ACLF, or survival after TIPS placement. However, female patients showed a significantly higher risk of bacterial infections after TIPS, despite more favorable clinical status at baseline. These findings suggest the need for reevaluation of gender-vigilant surveillance following TIPS placement. Publication History Article published online: 26 January 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Authors 31
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University Medical Center Freiburg
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Freiburg University Medical Center, Department of Internal Medicine II
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University Medical Center Freiburg
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Freiburg University Medical Center, Department of Internal Medicine II
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University Medical Center Freiburg
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Freiburg University Medical Center, Department of Internal Medicine II
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Affiliation as printed
Medizinische Klinik B, Münster University Hospital
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Medizinische Klinik B, Münster University Hospital
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Affiliation as printed
Department of Internal Medicine IV, Jena University Hospital
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Charité - Universitätsmedizin Berlin
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Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité University Medicine, Berlin
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Affiliation as printed
Medizinische Klinik B, Münster University Hospital
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University Medical Center of the Johannes Gutenberg University Mainz
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Klinik für Radiologie, University Medical Center Mainz
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University Medical Center of the Johannes Gutenberg University Mainz
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I. Medical Clinic, University Medical Center Mainz
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Medizinische Hochschule Hannover
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Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School
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Medizinische Hochschule Hannover
Affiliation as printed
Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité University Medicine, Berlin
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité University Medicine, Berlin
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University Medical Center Hamburg-Eppendorf
Affiliation as printed
I. Medizinische Klinik und Poliklinik, University Medical Center Hamburg-Eppendorf
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University Medical Center Hamburg-Eppendorf
Affiliation as printed
I. Medizinische Klinik und Poliklinik, University Medical Center Hamburg-Eppendorf
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Affiliation as printed
Klinik für Allgemeine Innere Medizin und Gastroenterologie, Immanuel Albertinen Diakonie Krankenhaus Hamburg
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Medical Clinic II, University Hospital RWTH Aachen, Aachen
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Medical Clinic II, University Hospital RWTH Aachen, Aachen
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Affiliation as printed
Medizinische Klinik und Poliklinik I, University Hospital Bonn
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Affiliation as printed
Medizinische Klinik und Poliklinik I, University Hospital Bonn
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University Medical Center Freiburg
Affiliation as printed
Zentrale klinische Forschung, Freiburg University Medical Center
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Affiliation as printed
Medizinische Klinik und Poliklinik I, University Hospital Bonn
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University Medical Center Freiburg
Affiliation as printed
Freiburg University Medical Center, Department of Internal Medicine II
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University Medical Center Freiburg
Affiliation as printed
Freiburg University Medical Center, Department of Internal Medicine II
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Affiliation as printed
Department of Internal Medicine IV, Jena University Hospital
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Affiliation as printed
Klinik für diagnostische und interventionelle Radiologie, St. Bernward Krankenhaus Hildesheim
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Affiliation as printed
Klinik für Radiologie, Universitätsklinikum Münster
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University Hospital Schleswig-Holstein
Affiliation as printed
Institut für Interventionelle Radiologie, University Hospital Schleswig Holstein – Campus Lübeck, Lübeck
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University Medical Center Freiburg
Affiliation as printed
Freiburg University Medical Center, Department of Internal Medicine II
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University Medical Center Freiburg
Affiliation as printed
Freiburg University Medical Center, Department of Internal Medicine II
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