Retrospective Study
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World J Gastrointest Surg. Feb 27, 2024; 16(2): 481-490
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.481
Correlation between serum markers and transjugular intrahepatic portosystemic shunt prognosis in patients with cirrhotic ascites
Xiao-Gang Hu, Xiao-Xian Yang, Jun Lu, Gang Li, Jian-Ji Dai, Jia-Min Wang, Yi Deng, Rui Feng
Xiao-Gang Hu, Jun Lu, Gang Li, Jian-Ji Dai, Jia-Min Wang, Yi Deng, Department of Interventional Radiology, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
Xiao-Xian Yang, Medical College, Jinhua Polytechnic, Jinhua 321017, Zhejiang Province, China
Rui Feng, Department of Interventional Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang Province, China
Author contributions: Hu XG and Feng R designed the study; Yang XX and Feng R wrote the manuscript; Hu XG, Yang XX, Deng Y, Li G, and Dai JJ performed the experiments; Lu J, Wang JM, Deng Y, and Feng R analyzed the data; and all the authors read and approved the final manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of Affiliated Jinhua Hospital, Zhejiang University School of Medicine.
Informed consent statement: The data used in the study were not involved in the patients’ privacy information, and all patient data obtained, recorded, and managed only used for this study, without any harm to the patient. So the informed consent was waived by the Ethics Committee of Affiliated Jinhua Hospital, Zhejiang University School of Medicine.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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/
Corresponding author: Rui Feng, MM, Attending Doctor, Department of Interventional Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou 310000, Zhejiang Province, China. fengrui596@yeah.net
Received: November 30, 2023
Peer-review started: November 30, 2023
First decision: December 18, 2023
Revised: December 30, 2023
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: February 27, 2024
Processing time: 87 Days and 6.5 Hours
ARTICLE HIGHLIGHTS
Research background

The transjugular intrahepatic portosystemic shunt (TIPS) is a frequently employed interventional technique for the management of hepatic ascites, yet uncertainties persist regarding its prognosis. Serum marker levels may play a crucial role in predicting the prognosis of patients with hepatic ascites who are undergoing TIPS procedures.

Research motivation

Currently, there is a lack of comprehensive research on the correlation between serum marker levels and the prognosis for TIPSs in hepatic ascites patients, resulting in a limited understanding of this topic. Consequently, the purpose of this study was to comprehensively explore the associations between various serum markers and the prognosis in individuals with hepatic ascites who underwent TIPS, with the aim of enhancing the precision of prognostic assessment and guiding treatment strategies.

Research objectives

This study aimed to investigate the associations between Child-Pugh score, model for end-stage liver disease (MELD) score, serum cystatin C (Cys C) level, and post-TIPS prognosis in patients with liver cirrhosis refractory ascites.

Research methods

We conducted a retrospective study involving 75 patients with decompensated liver cirrhosis and refractory ascites, all of whom underwent TIPS at our institution from August 2019 to August 2021. Over a two-year period, comprehensive follow-up assessments were undertaken, and patient outcomes were meticulously recorded. Clinical data, including Child-Pugh and MELD scores, were systematically collected. Spearman correlation analysis was used to evaluate the associations between the Child-Pugh score, MELD score, and Cys C level. The Cox proportional hazards model was used to identify independent risk factors influencing patient prognosis. Receiver operating characteristic curves were generated to assess the ability of Cys C levels, Child-Pugh scores, and MELD scores to predict the prognosis subsequent to TIPS treatment.

Research results

After 2 years of TIPS treatment, 40.00% of the 75 patients with refractory ascites due to liver cirrhosis passed away. Increased aspartate aminotransferase, alanine aminotransferase, total bilirubin, serum creatinine (Scr), prothrombin time, Cys C, international normalized ratio, Child-Pugh, and MELD scores were observed in the deceased group, while albumin and Na+ levels decreased (P < 0.05). The Child-Pugh score, MELD score, and Cys C concentration were identified as independent risk factors for the prognosis of TIPS treatment in patients with refractory ascites due to liver cirrhosis. Cys C showed slightly lower predictive accuracy for prognosis, with a sensitivity of 83.33% and specificity of 82.22%. The area under the curve was 0.883, with a cutoff value of 1.95 mg/L.

Research conclusions

Monitoring the serum Cys C concentration holds great value in assessing the prognosis in patients with refractory ascites due to liver cirrhosis after TIPS treatment. Compared to the use of Scr levels, predictive models based on serum Cys C levels are more beneficial for evaluating the condition and prognosis of patients with ascites due to cirrhosis.

Research perspectives

This study provides evidence of the correlation between serum biomarkers and the prognosis of patients undergoing TIPS, which may serve as a prognostic indicator. Nevertheless, additional validation and extension of the relationship between serum biomarkers and TIPS prognosis necessitate further inquiry. This entails conducting larger-sample clinical trials and exploring additional factors that may influence prognosis.