Guofeng Liu, Songchi Xiao, Xiaoze Wang, Yi Shen, Yuping He, Li Yang, Xuefeng Luo
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引用次数: 0
Abstract
Background: The optimal hemodynamic threshold for portal pressure gradient (PPG) following transjugular intrahepatic portosystemic shunt (TIPS) for ascites remains uncertain.
Objective: This study aimed to elucidate the relationship between post-TIPS PPG and clinical outcomes in patients undergoing small-diameter (8-mm) TIPS for ascites.
Design: Single-center retrospective study.
Methods: From June 2015 to June 2023, consecutive patients receiving small-diameter (8-mm) TIPS for refractory or recurrent ascites were considered for inclusion retrospectively. The impact of PPG on clinical outcomes-including ascites response, overt hepatic encephalopathy (OHE), further decompensation, and mortality-was evaluated using Fine and Gray competing risk regression models, both unadjusted and adjusted for potential confounders.
Results: A total of 143 patients were included in the analysis, of whom 65.7% had refractory ascites, with a median Child-Pugh score of 9. Receiver operating characteristic (ROC) curve analysis identified post-TIPS PPG as a reliable predictor of ascites response (cutoff: 10.5 mmHg, area under curves (AUC): 0.733, p < 0.001) and OHE (cutoff: 7.5 mmHg, AUC: 0.716, p < 0.001). Univariate and multivariate Fine and Gray competing risk regression analyses further revealed that patients with PPG between 8 and 10 mmHg had favorable outcomes, including a lower incidence of ascites (>10 vs 8-10 mmHg: hazard ratio (HR) = 5.74, 95% confidence interval (CI) 2.11-15.58, p < 0.001), a reduced risk of OHE (<8 vs 8-10 mmHg: HR = 2.87, 95% CI 1.29-6.35, p = 0.010), and a decreased risk of further decompensation (>10 vs 8-10 mmHg: HR = 2.78, 95% CI 1.43-5.41, p = 0.003; <8 vs 8-10 mmHg: HR = 2.42, 95% CI 1.20-4.90, p = 0.014) after TIPS placement.
Conclusion: This study revealed that post-TIPS PPG was associated with clinical outcomes in patients with refractory or recurrent ascites undergoing small-diameter TIPS. A post-TIPS PPG of 8-10 mmHg seems to be the optimal range, effectively controlling ascites without significantly increasing the risk of shunt-related hepatic encephalopathy, while also reducing the risk of further decompensation.
背景：经颈静脉肝内门静脉系统分流术（TIPS）治疗腹水后门静脉压力梯度（PPG）的最佳血流动力学阈值仍不确定。目的：本研究旨在阐明小直径（8mm）腹水TIPS术后PPG与临床结局的关系。设计：单中心回顾性研究。方法：回顾性分析2015年6月至2023年6月连续接受小直径（8mm） TIPS治疗难治性或复发性腹水的患者。PPG对临床结果的影响——包括腹水反应、显性肝性脑病（OHE）、进一步失代偿和死亡率——使用Fine和Gray竞争风险回归模型进行评估，包括未调整和调整潜在混杂因素。结果：共纳入143例患者，其中65.7%为难治性腹水，Child-Pugh评分中位数为9分。受试者工作特征（ROC）曲线分析发现，TIPS后PPG是腹水反应的可靠预测因子(截止值：10.5 mmHg，曲线下面积（AUC）： 0.733， p p 10 vs 8-10 mmHg：风险比（HR) = 5.74, 95%置信区间（CI） 2.11-15.58, p p = 0.010），以及TIPS放置后进一步失代偿的风险降低（bbb10 vs 8-10 mmHg: HR = 2.78, 95% CI 1.43-5.41, p = 0.003; p = 0.014）。结论：本研究显示，顽固性或复发性腹水患者行小直径TIPS后PPG与临床结局相关。tips后8-10 mmHg的PPG似乎是最佳范围，可有效控制腹水，而不会显著增加分流相关肝性脑病的风险，同时还可降低进一步代偿失代偿的风险。
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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