Copyright ©The Author(s) 2015.
World J Hepatol. Jul 8, 2015; 7(13): 1797-1806
Published online Jul 8, 2015. doi: 10.4254/wjh.v7.i13.1797
Table 1 Checklist summarizing compliance with meta-analysis of observational studies in Epidemiology Guidelines
MOOSE criteriaaMet (yes/no)
Reporting background should include
Problem definitionYes
Hypothesis statementNo
Description of study outcome(s)Yes
Type of exposure or intervention usedYes
Type of study designs usedYes
Study populationYes
Reporting of search strategy should include
Qualifications of searchers (e.g., librarians and investigators)Yes
Search strategy, including time period included in the synthesis and keywordsYes
Effort to include all available studies, including contact with authorsYes
Databases and registries searchedYes
Search software used, name and version, including special features used (e.g., explosion)Yes
Use of hand searching (e.g., reference lists of obtained articles)Yes
List of citations located and those excluded, including justificationYes
Method of addressing articles published in languages other than EnglishYes
Method of handling abstracts and unpublished studiesNo
Description of any contact with authorsNo
Reporting methods should include
Description of relevance or appropriateness of studies assembled for assessing the hypothesis to be testedYes
Rationale for the selection and coding of data (e.g., sound clinical principles or convenience)Yes
Documentation of how data were classified and coded (e.g., multiple raters, blinding, and interrater reliability)Yes
Assessment of confounding (e.g., comparability of cases and controls in studies where appropriate)No
Assessment of study quality, including blinding of quality assessors; stratification or regression on possible predictors of study resultsYes
Assessment of heterogeneityYes
Description of statistical methods (e.g., complete description of fixed or random effects models, justification of whether the chosen models account for predictors of study results, dose-response models, or cumulative meta-analysis) in sufficient detail to be replicatedYes
Provision of appropriate tables and graphicsYes
Reporting of results should include
Graphic summarizing individual study estimates and overall estimateYes
Table giving descriptive information for each study includedYes
Results of sensitivity testing (e.g., subgroup analysis)No
Indication of statistical uncertainty of findingsYes
Reporting of discussion should include
Quantitative assessment of bias (e.g., publication bias)NA
Justification for exclusion (e.g., exclusion of non-English-language citations)Yes
Assessment of quality of included studiesYes
Reporting of conclusions should include
Consideration of alternative explanations for observed resultsYes
Generalization of the conclusions (e.g., appropriate for the data presented and within the domain of the literature review)Yes
Guidelines for future researchYes
Disclosure of funding sourceYes
Table 2 Characteristics of 6 studies evaluating the effectiveness of transjugular intrahepatic portosystemic stent shunt in patients with refractory hepatic hydrothorax
Ref.Methods and patientsOutcomes/complicationsRemarks
Gordon et al[14]Retrospective chart review of 24 consecutive patients with medically RHHPost-TIPSS response was categorized as complete, partial, or absent11 patients had variceal bleeding > 4 wk before TIPSS
Post-TIPSS patients underwent Doppler US studies every 3 to 6 moMean change in HVPGStent revision if decreased flow noted
Mean follow-up was 7.2 mo (range, 0.25-49.0 mo)TIPSS patency was assessed by change in CTP score, survival, and new or worsened HE5 failures were CTP C
Patients with infection were excluded12 patients had medically RHH; the rest of the 9 patients had TIPSS and RHH as a secondary indication with the primary indication being intractable ascites (n = 7) and gastric varices (n = 2)
Jeffries et al[24]Retrospective chart review of 12 consecutive patients with medically RHHPost-TIPSS response at ≤ 1 or > 1 mowas categorized as complete, partial, or absentImmediate pre- and post-TIPSS prophylactic antibiotics given
Post-TIPSS, patients had Doppler US studies every 3 moTIPSS-related complications: ≤ 30 and > 30 dShunt thrombosis or decreased velocities requiredangioplastic revision
Mean follow-up was 173 d (range, 7-926 d)New-onset or worsened HE survival4 patients had shunt revisions
Patients with heart failure, HCC, alcoholic hepatitis, or intrinsic renal disease were excludedMean change in HVPGPatients who died or underwent transplant ≤ 30 d after TIPSS were classified as nonresponders to TIPSS
Siegerstetter et al[26]Retrospective chart review of 40 consecutive patients with medically RHHPost-TIPSS response was categorized as complete, partial, or absent8 patients had no ascites; RHH was diagnosed by intraperitoneal methylene blue injection or technetium-Tc-99
Post-TIPSS, patients had Doppler US studies at 4 wk, then every 3 moPredictors of survival:2 stent size reductions due to chronic HE
Mean (SD) follow-up was 14 moMean change in HVPG
[14 (range, 1-54 mo)]New-onset or worsened HE
Patients with infection were excludedCTP score improvement
Survival at 1 yr
Spencer et al[27]Retrospective chart review of 21 consecutive patients with medically RHH30-d mortalityProphylactic antibiotics administered
Post-TIPSS, patients had Doppler US studies at 1, 3, and 6 mo, then every 6 moPost-TIPSS complications: Early ( ≤ 30 d) or late(> 30 d)Radiographic and clinical response
Mean follow-up was 223 dNew-onset or worsened HETIPSS placement 100% successful
Patients with severe right-sided heart failure and patients with PVT with cavernous transformation were excludedPost-TIPSS response was categorized as complete, partial, or absent1 patient with a partial response was weaned off oxygen due to decreased pleural fluid
Mean change in HVPG
Cumulative survival
Wilputte et al[28]Retrospective chart review of 28 consecutive patients with medically RHHMean change in HVPGStent revised for stenosis, obstruction, or relapsing RHH
Post-TIPSS, patients had Doppler US at 24 h and at 1, 2, 3, 6, 9, and 12 mo, then every 6 mo30-d mortality post-TIPSSPatients who underwent transplant were censored at surgery date
Mean (SD) follow-up was 358 d (121 d); 3 patients were excluded due to grade 3 HE, HCC, cardiopulmonary disease, and infectionResponse to TIPSS was categorized as complete, partial, and absent6 patients required TIPSS revision
2 patients had TIPSS reduction due to intractable HE
Both covered and uncovered stents were used
Dhanasekaran et al[23]Retrospective chart review of 73 consecutive patients with medically RHHPost-TIPSS response at 1 mo and 6 mo was categorized as complete, partial, or absentTIPSS catheterization used if stenosis suspected or RHH reaccumulated
Patients had Doppler US every 3 mo for 12 mo, then annuallyEvaluated predictors of response to TIPSSAngioplasty performed, if needed
Patients with heart failure, pulmonary disease, infection, severe HE, portal vein thrombosis, and multiple hepatic cysts were excludedAssessed for new or worsening HEUncovered and covered stents used
Mean change in HVPG
Overall and 30-d mortality
Table 3 Summary of studies included in the pooled analyses of transjugular intrahepatic portosystemic shunt in patients with refractory hepatic hydrothorax
Ref.No. of patientsComplete response (%)Partial response (%)45-d mortality (%)1-yr survival (%)Predictors of mortality
Gordon et al[14]24582121NATIPSS nonresponse
CTP class C
Jeffries et al[24]12421725NAAge > 65 yr
Siegerstetter et al[26]4053281364Age > 60 yr
Spencer et al[27]21571029NAMedical comorbidities
Wilputte et al[28]2857111441CTP score > 10
Mayo score > 1.5
Dhanasekaran7359211948MELD > 15
et al[23]Nonresponse
Elevated creatinine