Presence of chronic complications differentiates in-hospital outcomes of transjugular intrahepatic portosystemic shunt in patients with diabetes mellitus

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences Pub Date : 2025-07-16 DOI:10.1016/j.amjms.2025.07.011

Renxi Li BS , SeungEun Lee BS , William Rienas BA , Shawn Sarin MD

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引用次数: 0

Abstract

Background

Transjugular intrahepatic portosystemic shunt (TIPS) is an interventional radiological procedure to reduce portal hypertension. Hyperglycemic state in diabetes mellitus (DM) is associated with vascular injuries that can lead to chronic complications, which is implicative of the extent/control of DM. This study aimed to use chronic complications as a marker for uncontrolled DM and examine major in-hospital outcomes after TIPS among DM patients with (DM-WCC) and without chronic complications (DM-WOCC).

Materials

Patients who underwent TIPS were identified in the National Inpatient Sample (NIS) from Q4 2015–2020. DM-WCC and DM-WOCC were identified using the Elixhauser comorbidity measure. In-hospital post-TIPS outcomes between DM-WCC, DM-WOCC, and non-DM patients were compared using multivariable logistic regression.

Results

NIS identified 1199 DM-WOCC, 1229 DM-WCC, and 4230 non-DM. Compared to non-DM, DM-WOCC had lower in-hospital mortality (aOR=0.661, 95 CI=0.493–0.885, p = 0.01) and renal complications (aOR=0.632, 95 CI=0.534–0.749, p < 0.01). Compared to non-DM, DM-WCC had higher renal complications (aOR=1.366, 95 CI=1.174–1.591, p < 0.01) and hepatic encephalopathy (HE; aOR=1.378, 95 CI=1.189–1.597, p < 0.01). Compared to DM-WOCC, DM-WCC had higher mortality (aOR=1.452, 95 CI=1.025–2.057, p = 0.04), renal complications (aOR=2.165, 95 CI=1.774–2.641, p < 0.01), and HE (aOR=1.247, 95 CI=1.045–1.487, p = 0.01). DM-WOCC had shorter length of stay and less total hospital costs than both DM-WCC and non-DM.

Conclusions

The presence of chronic complications in DM may differentiate the risk of complications after TIPS, where DM-WCC patients had worse outcomes, while DM-WOCC seems to be protective. Managing diabetic chronic complications may be helpful to avoid adverse outcomes after TIPS.

查看原文本刊更多论文

慢性并发症的存在区分糖尿病患者经颈静脉肝内门静脉分流术的住院结果。

背景：经颈静脉肝内门静脉系统分流术（TIPS）是一种降低门静脉高压症的介入放射治疗方法。糖尿病（DM）的高血糖状态与血管损伤相关，可导致慢性并发症，这与糖尿病的程度/控制有关。本研究旨在将慢性并发症作为糖尿病未控制的标志，并检查伴有（DM- wcc）和无慢性并发症（DM- wocc）的糖尿病患者在TIPS后的主要住院结果。材料：在2015-2020年第四季度的国家住院患者样本（NIS）中确定了接受TIPS的患者。DM-WCC和DM-WOCC采用Elixhauser合并症量表进行鉴定。采用多变量logistic回归对DM-WCC、DM-WOCC和非dm患者的tips后住院结果进行比较。结果：NIS共鉴定DM-WOCC 1199个，DM-WCC 1229个，非dm 4230个。与非糖尿病患者相比，DM- wocc患者的住院死亡率（aOR=0.661, 95 CI=0.493-0.885, p=0.01）和肾脏并发症（aOR=0.632, 95 CI=0.534-0.749, p）较低。结论：慢性并发症的存在可以区分TIPS术后并发症的风险，DM- wcc患者预后较差，而DM- wocc似乎具有保护作用。控制糖尿病慢性并发症可能有助于避免TIPS后的不良后果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of the Medical Sciences 医学-医学：内科

CiteScore

4.40

自引率

0.00%

发文量

303

审稿时长

1.5 months

期刊介绍： The American Journal of The Medical Sciences (AJMS), founded in 1820, is the 2nd oldest medical journal in the United States. The AJMS is the official journal of the Southern Society for Clinical Investigation (SSCI). The SSCI is dedicated to the advancement of medical research and the exchange of knowledge, information and ideas. Its members are committed to mentoring future generations of medical investigators and promoting careers in academic medicine. The AJMS publishes, on a monthly basis, peer-reviewed articles in the field of internal medicine and its subspecialties, which include: Original clinical and basic science investigations Review articles Online Images in the Medical Sciences Special Features Include: Patient-Centered Focused Reviews History of Medicine The Science of Medical Education.