A cohort study of transjugular intrahepatic portal systemic shunt in portal hypertension in cirrhosis

Abstract

Background TIPS can effectively reduce the portal pressure, alleviate clinical symptoms, PPG for the portal pressure gradient, studies show that for patients with esophageal and gastric varices rupture bleeding, postoperative PPG maintenance at 6-12mmHg is best, but these studies are for Europe and the United States population, for Asian portal hypertension with refractory ascites, what level of postoperative PPG is reasonable, there is no clear study., Therefore, we conducted this study. Methods This is a retrospective study of patients who received TIPS at multiple tertiary centers. Patients were recruited from January 2014 to December 2018 at Beijing Shijitan Hospital of Capital Medical University, PLA General Hospital and You'an Hospital affiliated to Capital Medical University. In this study, a total of 147 patients with cirrhosis with refractory ascites received TIPS. According to the postoperative PPG value of the enrolled patients, they were divided into three parts according to the order of small to large, and then the enrolled patients were divided into three groups: first group: 5mmHg < PPG < 12mmHg; second group: 13mmHg < PPG < 20mmHg; and third group: 21mmHg < PPG < 28mmHg. Statistical differences between the three groups in 5-year survival rate, the incidence of postoperative hepatic encephalopathy and postoperative ascites recurrence rate were calculated for the three groups. The 5-year survival rate of the three groups was 58.1%, 30%, and 22.2% (P = 0.002), among the three groups. The incidence of ascites recurrence in the three groups was 20.3%, 43.3% and 44.4% (P = 0.012), respectively, among the three groups. The incidence of hepatic encephalopathy in the three groups was 31.1%, 16.7% and 0% (P = 0.034), respectively, among the three groups. Result For patients with refractory ascites, postoperative maintenance of PPG in between 5 and 12mmHg can reduce the probability of postoperative hepatic encephalopathy and ascites recurrence, which has a good clinical guidance significance.