Zhang Q, Long L, Zhu HL, Peng H, Luo XH, Zhu KS, Wang RP. Predicting disease progression in cirrhotic patients after transjugular intrahepatic portosystemic shunt implantation: A sex-stratified analysis. World J Gastroenterol 2023; 29(42): 5768-5780 [PMID: 38075849 DOI: 10.3748/wjg.v29.i42.5768]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 14, 2023; 29(42): 5768-5780 Published online Nov 14, 2023. doi: 10.3748/wjg.v29.i42.5768
Predicting disease progression in cirrhotic patients after transjugular intrahepatic portosystemic shunt implantation: A sex-stratified analysis
Qian Zhang, Li Long, Hong-Lin Zhu, Hong Peng, Xin-Hua Luo, Kang-Shun Zhu, Rong-Pin Wang
Qian Zhang, Rong-Pin Wang, Department of Radiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Qian Zhang, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
Qian Zhang, Li Long, Hong Peng, Xin-Hua Luo, Department of Infectious Diseases, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Hong-Lin Zhu, Department of Interventional Radiology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Kang-Shun Zhu, Department of Interventional Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
Author contributions: Wang RP and Zhu KS conceptualized and designed the study; Long L and Zhu HL acquired the data; Zhang Q and Long L analyzed and interpreted the data; Zhang Q drafted the manuscript; Peng H and Luo XH critically revised the manuscript for important intellectual content; Zhang Q, Peng H, and Luo XH provided administrative, technical, or material support; Wang RP supervised the study; all authors made a significant contribution to this study and approved the final manuscript.
Institutional review board statement: This study was carried out in accordance with recommendations in the ethical guidelines of the latest version of the Declaration of Helsinki and those provided by the Guizhou Provincial People’s Hospital. The protocol was approved by the Ethics Committee of the Guizhou Provincial People’s Hospital.
Informed consent statement: Individual consent was waived for this retrospective analysis.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The clinical data used to support the findings of this study are available from the corresponding author at wangrongpin@126.com upon request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of item.
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/
Received: August 18, 2023 Peer-review started: August 18, 2023 First decision: September 18, 2023 Revised: September 30, 2023 Accepted: October 29, 2023 Article in press: October 29, 2023 Published online: November 14, 2023 Processing time: 87 Days and 5 Hours
Abstract
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) has been extensively used to treat portal hypertension-associated complications, including cirrhosis. The prediction of post-TIPS prognosis is important for cirrhotic patients, as more aggressive liver transplantation is needed when the post-TIPS prognosis is poor.
AIM
To construct a nutrition-based model that could predict the disease progression of cirrhotic patients after TIPS implantation in a sex-dependent manner.
METHODS
This study retrospectively recruited cirrhotic patients undergoing TIPS implantation for analysis. Muscle quality was assessed by measuring the skeletal muscle index (SMI) by computed tomography. Multivariate Cox proportional hazard models were utilized to determine the association between SMI and disease progression in cirrhotic patients after TIPS implantation.
RESULTS
This study eventually included 186 cirrhotic patients receiving TIPS who were followed up for 30.5 ± 18.8 mo. For male patients, the 30-mo survival rate was significantly lower and the probability of progressive events was higher (3.257-fold) in the low-level SMI group than in the high-level SMI group. According to the multivariate Cox analysis of male patients, SMI < 32.8 was an independent risk factor for long-term adverse outcomes after TIPS implantation. A model was constructed, which involved creatinine, plasma ammonia, SMI, and acute-on-chronic liver failure and hepatic encephalopathy occurring within half a year after surgery. This model had an area under the receiver operating characteristic curve of 0.852, sensitivity of 0.926, and specificity of 0.652. According to the results of the DeLong test, this model outperformed other models (Child-Turcotte-Pugh, Model for End-Stage Liver Disease, and Freiburg index of post-TIPS survival) (P < 0.05).
CONCLUSION
SMI is strongly associated with poor long-term outcomes in male patients with cirrhosis who underwent TIPS implantation.
Core Tip: Our study highlights the strong association between the skeletal muscle index and long-term adverse outcomes in male patients with cirrhosis who received transjugular intrahepatic portosystemic shunt (TIPS) implantation, reflecting the necessity for adequate sex-stratified analysis. Additionally, nutritional indicator-based models hold tremendous promise for effectively predicting the prognosis of cirrhotic patients undergoing TIPS implantation and assisting clinicians in closely monitoring high-risk populations.
