Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2022; 28(41): 5944-5956
Published online Nov 7, 2022. doi: 10.3748/wjg.v28.i41.5944
Transjugular intrahepatic portosystemic shunt vs conservative treatment for recurrent ascites: A propensity score matched comparison
Martin Philipp, Theresia Blattmann, Jörn Bienert, Kristian Fischer, Luisa Hausberg, Jens-Christian Kröger, Thomas Heller, Marc-André Weber, Georg Lamprecht
Martin Philipp, Theresia Blattmann, Jörn Bienert, Kristian Fischer, Luisa Hausberg, Georg Lamprecht, Department of Medicine, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock 18057, Germany
Jens-Christian Kröger, Thomas Heller, Marc-André Weber, Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Centre, Rostock 18057, Germany
Author contributions: Philipp M, Blattmann T, Bienert J, Fischer K, and Hausberg L designed the research study and acquired the data; Philipp M and Lamprecht G analyzed the data and wrote the manuscript; Kröger JC, Heller T, and Weber MA performed transjugular intrahepatic portosystemic shunt placement and critically revised the manuscript; all authors have read and have approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Rostock University Medical Center (Approval No. A2018-0127).
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board considering the retrospective design of the study. Nevertheless, informed consent was obtained from all available patients.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: De-identified data and statistical code used in this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Georg Lamprecht, MD, Academic Research, Director, Doctor, Full Professor, Department of Medicine, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, 6 Ernst-Heydemann-Street, Rostock 18057, Germany. georg.lamprecht@med.uni-rostock.de
Received: July 9, 2022
Peer-review started: July 9, 2022
First decision: September 2, 2022
Revised: September 15, 2022
Accepted: October 19, 2022
Article in press: October 19, 2022
Published online: November 7, 2022
Processing time: 117 Days and 11 Hours
Abstract
BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) placement is an effective intervention for recurrent tense ascites. Some studies show an increased risk of acute on chronic liver failure (ACLF) associated with TIPS placement. It is not clear whether ACLF in this context is a consequence of TIPS or of the pre-existing liver disease.

AIM

To better understand the risks of TIPS in this challenging setting and to compare them with those of conservative therapy.

METHODS

Two hundred and fourteen patients undergoing their first TIPS placement for recurrent tense ascites at our tertiary-care center between 2007 and 2017 were identified (TIPS group). Three hundred and ninety-eight patients of the same time interval with liver cirrhosis and recurrent tense ascites not undergoing TIPS placement (No TIPS group) were analyzed as a control group. TIPS indication, diagnosis of recurrent ascites, further diagnoses and clinical findings were obtained from a database search and patient records. The in-hospital mortality and ACLF incidence of both groups were compared using 1:1 propensity score matching and multivariate logistic regressions.

RESULTS

After propensity score matching, the TIPS and No TIPS groups were comparable in terms of laboratory values and ACLF incidence at hospital admission. There was no detectable difference in mortality (TIPS: 11/214, No TIPS 13/214). During the hospital stay, ACLF occurred more frequently in the TIPS group than in the No TIPS group (TIPS: 70/214, No TIPS: 57/214, P = 0.04). This effect was confined to patients with severely impaired liver function at hospital admission as indicated by a significant interaction term of Child score and TIPS placement in multivariate logistic regression. The TIPS group had a lower ACLF incidence at Child scores < 8 points and a higher ACLF incidence at ≥ 11 points. No significant difference was found between groups in patients with Child scores of 8 to 10 points.

CONCLUSION

TIPS placement for recurrent tense ascites is associated with an increased rate of ACLF in patients with severely impaired liver function but does not result in higher in-hospital mortality.

Keywords: Liver cirrhosis; Ascites; Transjugular intrahepatic portosystemic shunt; Acute on chronic liver failure; Mortality; Propensity score

Core Tip: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for recurrent tense ascites, but there are concerns about further deterioration of liver function in patients with advanced cirrhosis. We retrospectively analyzed 214 patients receiving TIPS for ascites and compared their outcomes to matched conservatively treated patients. We found that TIPS can trigger acute on chronic liver failure (ACLF) in patients with severely impaired liver function. However, no increased mortality was found compared to conservatively treated patients. Despite an increased risk of ACLF, TIPS is a viable option for patients with ascites and hepatic impairment.