Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt

Table 1 Characteristics of patients before transjugular intrahepatic portosystemic shunt

Characteristic	Total	Shunting branch of the PV		Initial stent position
	(n = 307)	Left (n = 221)	Right (n = 86)	Optimal (n = 224)	Sub-optimal (n = 83)
Age (yr)	50.7 ± 12.8	50.0 ± 12.9	52.5 ± 12.3	50.8 ± 12.6	50.4 ± 13.3
Gender (male/female)	209/98	151/70	58/28	147/77	62/21
TIPS procedure (elective/emergency)	258/49	190/31	68/18	190/34	68/15
Etiology (viral/not viral1)	275/32	199/22	76/10	197/27	78/5
Ascites (no/yes)	94/213	74/147	20/66	69/155	25/58
Previous HE (no/yes)	298/9	214/7	84/2	218/6	80/3
Previous splenectomy (no/yes)	252/55	179/42	73/13	184/40	68/15
Platelet count (109/L)	82.3 ± 65.4	82.3 ± 68.9	82.6 ± 55.8	85.5 ± 68.4	73.9 ± 56.2
Albumin (g/L)	33.3 ± 5.2	33.4 ± 5.0	32.9 ± 5.9	33.1 ± 5.2	33.8 ± 5.2
Total bilirubin (μmol/L)	24.7 ± 19.2	24.3 ± 18.1	25.7 ± 21.7	24.0 ± 17.8	26.4 ± 22.4
INR	1.3 ± 0.3	1.3 ± 0.3	1.3 ± 0.3	1.3 ± 0.3	1.3 ± 0.3
Serum creatinine (μmol/L)	82.4 ± 21.8	82.3 ± 21.9	82.6 ± 21.6	81.0 ± 21.2	86.2 ± 22.9
Sodium (mmol/L)	138.9 ± 4.7	139.0 ± 4.3	138.4 ± 5.6	138.6 ± 5.0	139.6 ± 3.6
Child-Pugh score	7.1 ± 1.6	7.1 ± 1.6	7.3 ± 1.7	7.1 ± 1.7	7.1 ± 1.5
Child-Pugh classification (A/B/C)	126/157/24	94/110/17	32/47/7	93/111/20	33/46/4
MELD score	11.1 ± 3.3	11.1 ± 3.3	11.1 ± 3.5	11.2 ± 3.5	10.8 ± 2.7
Pre-TIPS PSG (mmHg)	22.3 ± 4.5	22.5 ± 4.3	21.7 ± 4.9	22.4 ± 4.6	22.0 ± 4.2
Reduction ratio of PSG (%)	45.8 ± 17.4	46.3 ± 17.4	44.5 ± 17.3	45.7 ± 17.4	45.9 ± 17.5
Stent diameter (8-/10-mm)	206/101	150/71	56/30	150/74	56/27
Shunting branch of the PV (right/left)	86/221	-	-	57/164	26/60
Initial stent position (optimal/suboptimal)	224/83	164/57	60/26	-	-
TIPS date2 (before 2006/after 2006)	118/189	75/146	43/433	83/141	35/48
Lost to follow-up	19	12	7	15	4

¹Cirrhosis caused by autoimmune diseases (n = 11), cirrhosis caused by medications (n = 4), schistosome (n = 1) or nonalcoholic steatohepatitis (n = 2);

²The date of TIPS procedure;

³The comparison between groups was significantly different. HE: Hepatic encephalopathy; PSG: Portosystemic pressure gradient; INR: International normalized ratio; MELD: Model for end-stage liver diseases; PV: Portal vein.

Table 2 Results from the univariate analyses

Variable	Hepatic encephalopathy			Shunt dysfunction			Survival
	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value
Age (yr)	1.03	1.01-1.04	< 0.001	0.99	0.97-1.01	NS	1.01	0.99-1.03	NS
Gender (male/female)	1.04	0.72-1.50	NS	1.62	1.07-2.45	0.023	1.41	0.92-2.16	NS
TIPS procedure (elective/emergency)	1.37	0.88-2.13	NS	0.66	0.38-1.14	NS	1.57	1.02-2.41	0.041
Ascites (yes/no)	1.55	1.04-2.30	0.031	0.90	0.62-1.33	NS	2.22	1.38-3.57	0.001
Previous splenectomy (yes/no)	0.97	0.61-1.54	NS	1.65	1.09-2.50	0.018	0.61	0.36-1.02	NS
Platelet count (109/L)	1.00	0.99-1.01	NS	1.00	0.99-1.01	NS	0.99	0.99-1.00	0.021
Albumin (g/L)	0.96	0.93-0.99	0.022	0.98	0.95-1.02	NS	0.96	0.92-0.99	0.035
Total bilirubin (μmol/L)	1.00	0.99-1.01	NS	1.00	0.99-1.01	NS	1.01	1.00-1.02	0.002
INR	2.09	1.20-3.64	0.009	0.82	0.41-1.63	NS	3.12	1.86-5.23	< 0.001
Child-Pugh score	1.17	1.06-1.29	0.003	1.01	0.90-1.13	NS	1.29	1.15-1.44	< 0.001
MELD score	1.05	1.01-1.11	0.032	0.97	0.91-1.03	NS	1.09	1.04-1.14	< 0.001
Reduction ratio of PSG (%)	1.02	1.01-1.03	0.004	0.99	0.98-1.01	NS	1.01	0.99-1.02	NS
Shunting branch of the PV (right /left)	1.75	1.22-2.52	0.003	0.81	0.53-1.23	NS	2.10	1.43-3.07	< 0.001
Initial stent position (sub-optimal/optimal)	0.75	0.49-1.15	NS	2.24	1.54-3.25	< 0.001	1.88	1.44-2.47	< 0.001
HE within 6 mo (yes/no)	-	-	-	-	-	-	1.60	1.07-2.38	0.021
Shunt dysfunction within 6 mo (yes/no)	-	-	-	-	-	-	1.87	1.15-3.04	0.011

HE: Hepatic encephalopathy; PSG: Portosystemic pressure gradient; INR: International normalized ratio; MELD: Model for end-stage liver diseases; PV: Portal vein; NS: Non-significant; TIPS: Transjugular intrahepatic portosystemic shunt.

Table 3 Risk factors from the multivariate analyses

Variable	Multivariate analysis
	HR	95%CI	P value
Hepatic encephalopathy
Age	1.02	1.01-1.04	0.001
INR	2.01	1.15-3.50	0.014
Child-Pugh score	1.17	1.05-1.31	0.004
MELD	1.06	1.01-1.11	0.021
Shunting branch of the PV (right/left)	1.59	1.10-2.30	0.014
Reduction ratio of PSG (%)	1.01	1.00-1.03	0.009
Shunt dysfunction
Previous splenectomy (yes/no)	1.76	1.16-2.67	0.008
Initial stent position (sub-optimal/optimal)	2.30	1.57-3.35	< 0.001
Survival
Ascites (yes/no)	1.87	1.13-3.08	0.014
INR	2.31	1.34-3.98	0.003
Shunting branch of the PV (right/left)	1.92	1.30-2.84	0.001
Initial stent position (sub-optimal/optimal)	1.68	1.12-2.50	0.011
Child-Pugh score	1.27	1.13-1.43	< 0.001
MELD	1.09	1.03-1.14	0.003
HE within six months (yes/no)	1.54	1.02-2.35	0.043
Shunt dysfunction within 6 mo (yes/no)	2.48	1.47-4.19	0.001

INR: International normalized ratio; PV: Portal vein; MELD: Model for end-stage liver diseases; HE: Hepatic encephalopathy; PSG: Portosystemic pressure gradient.