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Prediction of mortality and overt hepatic encephalopathy undergoing transjugular intrahepatic portosystemic shunt: a retrospective cohort study

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Data on medium- and long-term efficacy and safety of Transjugular intrahepatic portosystemic shunt (TIPS) using Viatorr stents in Chinese patients are limited. This study aimed to evaluate the 5-year mortality and the incidence of overt hepatic encephalopathy (OHE) after Viatorr stent insertion, and construct a model to predict post-TIPS OHE preoperatively.

Methods

One hundred thirty-two patients undergoing Viatorr stent insertion in our institution between August 2016 and December 2019 were included, and randomly divided into training and validation cohort at a 70/30 ratio. Patients were followed up until death or the end date of follow-up (December 31st, 2021). The primary end point was all-cause mortality, and the secondary end points were OHE, variceal rebleeding, recurrent ascites and shunt dysfunction.

Results

The 1-, 2-, 3-, 4- and 5-year cumulative survival rates were 92.4%, 87.9%, 85.3%, 80.2% and 80.2%, respectively. Post-TIPS OHE and Child-Pugh grade were independent prognostic factors. The rates of variceal rebleeding, recurrent ascites, shunt dysfunction and post-TIPS OHE were 9.1%, 14.3%, 5.3% and 28.0%, respectively. The variables of nomogram predicting post-TIPS OHE included age, diabetes and ascites grade. The area under time-dependent receiver operation characteristic (ROC) curve (AUC) in training and validation cohort were 0.806 and 0.751, respectively. The decision curve analysis (DCA) showed good net benefit both in training and validation cohort.

Conclusion

Post-TIPS OHE and Child-Pugh grade are independent prognostic factors for early mortality in cirrhosis patients, thus we construct a simple and convenient prediction model for post-TIPS OHE to identify high-risk patients preoperatively.

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Acknowledgements

This study was supported by grants from the Science Foundation of Education Department of Yunnan province (Grant No. 2022J0243) and the Clinical Research Program of the Second Affiliated Hospital of Kunming Medical University (Grant No. ynIIT2022009).

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Authors and Affiliations

  1. Department of Pharmacy, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650101, Yunnan, China

    Kejia Li

  2. Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650101, Yunnan, China

    Yu Cheng

  3. Department of Interventional radiology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650101, Yunnan, China

    Ruimin Zhao, Hua Jiang, Lei Zhang, Yuyun Tong & Songwei Li

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  1. Kejia Li
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Correspondence to Songwei Li.

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Ethical approval

The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Kunming Medical University (No. PJ-2022-147).

Research involving human and animal participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Li, K., Cheng, Y., Zhao, R. et al. Prediction of mortality and overt hepatic encephalopathy undergoing transjugular intrahepatic portosystemic shunt: a retrospective cohort study. Abdom Radiol 49, 908–918 (2024). https://doi.org/10.1007/s00261-023-04086-7

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