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Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion

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Abstract

Background

Malnutrition is common in patients with cirrhosis and is associated with poor outcomes after hepatic resection and liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) is performed for complications of cirrhosis.

Aim

To assess the impact of malnutrition on TIPS outcomes.

Methods

A retrospective analysis was performed using the Healthcare Cost and Utilization Project: National Inpatient Sample database for TIPS procedures from 2005 to 2014. The primary end point was in-hospital mortality. The association of specific malnutrition diagnostic codes and race–ethnicity on mortality was evaluated with survey-weighted logistic regression adjusted for age, gender, admission type, insurance payer, hospital region, comorbidities, and length of stay (LOS).

Results

From 2005 to 2014, an estimated 53,207 (95% CI 49,330–57,085) admissions with TIPS occurred. A diagnosis of malnutrition was present in 11%. In-hospital death post-TIPS occurred in 15.0% versus 10.7% (p value < 0.001) of patients with and without malnutrition, respectively. Patients with malnutrition had longer post-procedural LOS (median 6.7 vs. 2.9 days, p value < 0.001) and greater total hospital charges (median $144,752 vs. $79,781, p value < 0.001) and were more likely to be discharged to a skilled nursing facility (21.6% vs. 9.7%) than patients without malnutrition. Patients with malnutrition had increased odds of mortality (OR 1.31, 95% CI 1.07, 1.59) compared to patients with no malnutrition.

Conclusion

Malnutrition was associated with worse outcomes after TIPS. Further research is needed to understand the mechanism of malnutrition in post-procedure outcomes and the ability of interventions for nutritional optimization to improve outcomes.

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Authors and Affiliations

  1. Duke University School of Medicine, 2530 Erwin Road APT 254, Durham, NC, 27705, USA

    Ryan S. Chiang

  2. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, DUMC 2721, Durham, NC, 27710, USA

    Alice Parish & Donna Niedzwiecki

  3. Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, DUMC 3923, Durham, NC, 27710, USA

    Matthew R. Kappus & Andrew J. Muir

  4. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA

    Andrew J. Muir

  5. Duke Cancer Institute-Biostatistics, Hock Plaza I, 2424 Erwin Rd, Suite 802, Room 8040, Durham, NC, 27705, USA

    Donna Niedzwiecki

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  1. Ryan S. Chiang
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Correspondence to Andrew J. Muir.

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Conflict of interest

Chiang RS, Parish A, Niedzwiecki D, Kappus MR: No disclosures. Muir, AJ: Dr. Muir has received research Grants from Abbvie, Dova, Gilead, GSK, Merck, NGM, Proteus, and Taiwan. He has served on advisory boards for Abbvie, Dova, Gilead, Merck, Precision Biosciences, and Shionogi.

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Chiang, R.S., Parish, A., Niedzwiecki, D. et al. Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion. Dig Dis Sci 65, 3332–3340 (2020). https://doi.org/10.1007/s10620-019-06038-y

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  • DOI: https://doi.org/10.1007/s10620-019-06038-y

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