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

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.