Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications

Table 1 Baseline characteristics

Characteristics	Group A	Group B	Pvalue	Group C	Group D	Pvalue
Gender, M/F	256/223	237/175	0.369	126/91	93/79	0.319
Age (mean ± SD) (yr)	54.616 ± 17.27	56.39 ± 12.19	0.319	56.24 ± 13.67	58.27 ± 13.25	0.246
Child–Pugh A/B/C	39/342/98	32/318/62	0.187	0/60/157	0/41/131	0.215
MELD score (mean ± SD)	8.42 ± 1.37	9.29 ± 2.16	0.576	13.26 ± 4.56	14.39 ± 5.38	0.472
Viral hepatitis	324	276	0.528	136	107	0.632
Chronic ethanol consumption	102	87	0.317	55	38	0.258
Cryptogenic hepatitis	53	49	0.492	26	27	0.146
Variceal hemorrhage	479	412	0.721	0	0	0
Refractory ascites	0	0	0	217	172	0.562
Laboratory tests
Alanine transaminase (U/L)	48.36 ± 4.21	53.19 ± 3.27	0.462	62.13 ± 6.48	57.49 ± 7.29	0.368
Aspartate Transaminase (U/L)	54.17 ± 9.25	58.27 ± 12.37	0.361	67.43 ± 15.7	64.28 ± 17.24	0.357
Alkaline phosphatase (U/L)	145.36 ± 23.45	167.18 ± 27.36	0.382	89.67 ± 13.24	92.36 ± 16.58	0.413
γ-Glutamyl transpeptidase (U/L)	278.54 ± 37.47	259.74 ± 46.37	0.463	364.27 ± 58.74	382.17 ± 47.26	0.482
Total bilirubin (mmol/L)	29.45 ± 3.17	32.46 ± 4.28	0.147	37.18 ± 7.69	35.24 ± 8.54	0.367
Albumin (g/L)	31.28 ± 1.47	32.07 ± 1.25	0.106	28.07 ± 1.29	29.36 ± 1.48	0.294
Prothrombin time (s)	14.02 ± 1.35	15.04 ± 1.19	0.236	18.12 ± 2.39	19.23 ± 2.41	0.241
Clinical presentations
Abdominal distention	89	93	0.261	217	172	0.562
Abdominal pain	48	52	0.273	134	97	0.183
Weakness	364	314	0.148	189	154	0.136
Poor appetite	373	362	0.302	196	153	0.324
Jaundice	28	24	0.532	21	16	0.214
Splenomegaly	264	249	0.357	205	168	0.436
Lower limbs edema	47	62	0.159	189	157	0.327
Ascites paracentesis	0	0	0	217	172	0.562
Endoscopic therapy	453	407	0.372	0	0	0

No difference (P > 0.05) could be seen in terms of age, sex, Child–Pugh score, MELD score, laboratory tests, and clinical presentations. MELD: Model of End-Stage Liver Disease; SD: Standard deviation; M: Male; F: Female.

Table 2 Portosystemic gradient changes in the two groups

Groups	PSG (mmHg)		tvalue	Pvalue
	Before	After
Group A	24.58 ± 2.41	15.72 ± 1.04	11.48	0.012
Group B	25.37 ± 2.54	11.27 ± 2.04	14.25	0.004
	(t value) 0.649	6.382
	(P value) 0.483	0.026
Group C	25.12 ± 3.16	16.15 ± 1.37	12.43	0.016
Group D	24.48 ± 3.24	10.28 ± 1.18	15.47	0.003
	(t value) 0.367	5.734
	(P value) 0.534	0.017

There are differences before and after transjugular intrahepatic portosystemic shunt in the four groups: group A compared with B, and group C compared with D. PSG: Portosystemic gradient.

Table 3 Outcomes of symptoms in the four groups

Symptoms	Group A	Group B	χ2	Pvalue	Group C	Group D	χ2	Pvalue
Ascites within 1 wk	/	/		/	198 (198/217, 91.24%)	161 (161/172, 93.60%)		0.327
Hemorrhage within 1 wk	0	0		0	/	/		/
Primary unassisted patency rate	0.8641	0.8724	4.486	0.257	0.8531	0.8429	4.529	0.248
Hepatic function compromise	43 (43/479, 8.97%)	96 (96/412, 23.30%)	11.352	0.005	27 (27/217, 12.44%)	63 (63/172, 36.62%)	13.758	0.002
Recurrence of hemorrhage	56 (56/479, 11.69%)	47 (47/412, 11.40%)	7.062	0.374	/	/	/	/
Stent dysfunction	27 (27/479, 5.63%)	21 (21/412, 5.09%)	6.834	0.358	/	/	/	/
Non-stent dysfunction	29 (29/479, 6.05%)	26 (26/412, 6.31%)	6.486	0.362	/	/	/	/
Recurrence of ascites	/	/	/	/	89 (89/217, 41.01%)	126 (126/172,73.25%)	14.493	0.006
Stent dysfunction	/	/	/	/	13 (13/217, 5.99%)	9 (9/172, 5.23%)	4.574	0.375
Non-stent dysfunction	/	/	/	/	76 (76/217, 35.02%)	117 (117/172, 68.02%)	13.356	0.006

Table 4 Hepatic encephalopathy occurrence in the four groups

Time	Group	HE occurrence		Occurrence rate (%)	χ2	Pvalue
		Yes	No
1 mo	A	43	436	8.97	6.463	0.027
	B	67	345	16.26
	C	27	190	12.44	14.673	0.014
	D	41	131	23.83
3 mo	A	45	434	9.39	5.368	0.023
	B	79	333	19.17
	C	39	178	17.97	17.478	0.009
	D	83	89	48.25
6 mo	A	39	440	8.14	6.473	0.017
	B	72	340	17.47
	C	31	186	14.28	13.957	0.011
	D	74	98	43.02
1 year	A	36	443	7.51	4.538	0.027
	B	61	351	14.8
	C	29	188	13.36	14.576	0.014
	D	69	103	40.11
2 year	A	34	445	7.09	5.452	0.026
	B	49	363	11.89
	C	23	194	10.59	11.476	0.013
	D	54	118	31.39
3 year	A	29	443	6.14	5.467	0.028
	B	43	369	10.43
	C	17	155	9.88	8.473	0.017
	D	42	130	24.41
Total HE rate	A	46	433	9.6	7.932	0.016
	B	67	158	16.26
	C	47	170	21.65	13.637	0.007
	D	69	103	40.11

There were significant differences in incidence of hepatic encephalopathy in group A compared with groups B–D at 1, 3, 6 and 9 mo, and 1, 2 and 3 years (P < 0.05). HE: Hepatic encephalopathy.

Table 5 Survival at 3 and 6 mo, and 1, 2 and 3 years

Time	Group	Survival		Survival rate (%)	χ2	Pvalue
		Yes	No
3 mo	A	470	9	98.12	5.368	0.425
	B	401	11	97.33
	C	184	33	84.79	13.364	0.012
	D	127	45	73.83
6 mo	A	442	37	92.27	4.557	0.436
	B	381	31	92.47
	C	162	55	74.65	12.463	0.013
	D	107	65	62.2
1 year	A	397	82	82.88	4.562	0.427
	B	335	77	81.31
	C	117	100	53.91	12.568	0.016
	D	65	107	37.79
2 year	A	293	186	61.16	5.487	0.382
	B	245	167	59.46
	C	59	158	27.18	11.467	0.017
	D	26	146	15.11
3 year	A	229	250	47.8	4.582	0.375
	B	193	219	46.84
	C	32	185	14.74	10.367	0.027
	D	16	156	9.3
Total survival rate	A	217	262	45.3	3.376	0.369
	B	178	234	43.2
	C	28	189	12.9	13.582	0.014
	D	12	160	6.97

Survival rates showed no significant differences between groups A and B (P > 0.05), but there were significant differences between groups C and D.