Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study

Table 1 Baseline characteristics of the 87 patients at enrollment

Characteristic
Age (yr)	58.1 ± 7.6
Male	68 (78.2)
Etiology of cirrhosis
Alcohol	71 (81.6)
Viruses	12 (13.8)
NASH	7 (8.0)
Others	2 (2.3)
TIPS indication
Recurrent bleeding	30 (34.5)
Refractory ascites	59 (67.8)
Hydrothorax	4 (4.6)
Child-Pugh score, n = 86	7.8 ± 1.6
Child-Pugh score, n = 86
A	18 (20.9)
B	58 (67.4)
C	10 (11.6)
MELD score	11.6 ± 3.4

Data are mean ± SD or n (%). MELD: Model for end-stage liver disease.

Table 2 Suspicion of dysfunction based on the conclusion of the operator, according to the localization of the stenosis n (%)

	Dysfunction suspected (n = 21 stenosis)	Not suspected (n = 18 stenosis)
Lower part of the stent	6 (28.6)	2 (11.1)
Middle part of the stent	4 (19.1)	4 (22.2)
Upper part of the stent	8 (38.1)	8 (44.4)
Hepatic vein	3 (14.3)	4 (22.2)

Table 3 Performance of Doppler-ultrasonography binary criteria for the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction

Variables	n paired	n patients	Sensitivity (95%CI)	Specificity (95%CI)	PPV	NPV (95%CI)
Portal flow modulation	177	73	44.4 (31.2-57.6)	79.6 (67.3-91.4)	56.4 (37.8-76.3)	71.1 (62.6-78.8)
Direction in right branch	173	76	57.2 (44.6-70.1)	61.7 (48.9-73.1)	45.2 (33.7-58.3)	72.4 (62.6-80.5)
Direction in left branch	171	77	54.7 (39.6-69.7)	66.8 (54.4-78.1)	48.5 (34.8-63.8)	72.1 (61.3-82.3)
Stent filling	140	64	31.3 (18.8-44.2)	81.8 (72.4-89.8)	54.1 (36.0-71.0)	63.4 (52.2-73.6)
Ascites	218	87	27.9 (16.9-39.7)	90.6 (84.0-95.4)	62.9 (43.7-79.1)	68.7 (61.0-76.1)
Conclusion	218	87	39.1 (27.6-51.4)	87.1 (79.3-93.3)	63.5 (45.8-79.8)	71.5 (63.6-78.5)

PPV: Positive predictive value; NPV: Negative predictive value.

Table 4 Performance of Doppler-ultrasonography quantitative criteria for the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction

	Patients	Paired procedures	AUC	95%CI
Portal velocity	80	192	0.655	0.553-0.749
Stent velocity	80	195	0.536	0.454-0.634
Portal velocity delta	63	150	0.577	0.485-0.679
Delta + right direction	58	128	0.626	0.530-0.726

AUC: Area under the curve.