Development of a Drum Tower Severity Scoring (DTSS) system for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome

Wang, Xuan; Zhang, Wei; Zhang, Ming; zhang, Feng; Xiao, Jiangqiang; Yin, Qin; Hao, Han; Li, Taishun; Lin, Ge; Zhuge, Yuzheng

doi:10.1007/s12072-021-10293-5

Cited by 11 publications

(3 citation statements)

References 20 publications

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“…Furthermore, patients were all Chinese and received standard care in China, our findings require validation before generalizing to other populations with different settings. At last, we did not use DTSS grading system which was dedicated to PA-HSOS [19] due to lack of important data, such as peak portal vein velocity. Despite the limitations, the current study advances our knowledge on how to select patients for early intervention and provides preliminary results to support anticoagulant therapy for this special population.…”

Section: Discussionmentioning

confidence: 99%

Prognostic risk factors for patients with hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids

Liu

et al. 2023

Medicine

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Pyrrolizidine alkaloids induced hepatic sinusoidal obstruction syndrome (PA-HSOS) often occurs after consuming herbs or a dietary supplement containing the plant Tu-San-Qi. Limited data exists to identify patients with fatal outcomes for early interventions. We aimed to analyze the predictors for 3-month survival. We retrospectively enrolled PA-HSOS patients in 5 hospitals and extracted data from the onset of PA-HSOS to 36 months. Outcome measurements were 3-month and 36-month survival rates, baseline prognostic predictors for survival, and the effects of anticoagulant therapy. Among 49 enrollees, the median age was 60 and 49% male. At the onset of PA-HSOS, patients with Child-Turcotte-Pugh (CTP) class of A, B, or C were 8.2% (4/49), 42.8% (21/49) and 49.0% (24/49), respectively. None of them received a transjugular intrahepatic portosystemic shunt or a liver transplant. The 3-month and 36-month survival rates were 86% and 76%, respectively. Compared to the CTP class A or B, class C at baseline independently predicted lower survival rates at both 3 and 36 months. However, anticoagulation therapy treatment within the first 3 months independently predicted significantly higher survival rates at both time points. CTP class C and anticoagulant therapy were the independent predictors for short-term and long-term survival. Anticoagulant therapy could decrease mortality rate of CTP class C patients. The greatest benefit of anticoagulant evaluated by 3-month survival rate was in patients with CTP class C compared with those without treatment (93% vs 40%, P = .009). There were no bleeding complications reported in patients treated with the anticoagulant.

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Section: Discussionmentioning

confidence: 99%

Prognostic risk factors for patients with hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids

Liu

et al. 2023

Medicine

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“…Anticoagulation-TIPS step therapy is the most common treatment modality for acute or subacute PA-HSOS [ 8 , 17 , 18 , 19 ]. In addition, previous studies have shown that TIPS reverses progression in patients who have failed anticoagulation for PA-HSOS, with significant reductions in PP after TIPS treatment and survival rates of 80–90% [ 17 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Agreement between Wedged Hepatic Venous Pressure and Portal Pressure in Hepatic Sinusoidal Obstruction Syndrome

Cheng

Gu²,

Yin³

et al. 2022

JPM

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Background: Wedge hepatic vein pressure (WHVP) accurately estimates the portal pressure (PP) in chronic sinusoidal portal hypertension patients. Whether this applies to patients with acute portal hypertension due to hepatic sinusoidal obstruction syndrome (HSOS) is unclear. Our aim was to assess the agreement between WHVP and PP in patients with HSOS by comparing them to decompensated cirrhosis patients. Methods: From December 2013 to December 2021, patients with pyrrolidine alkaloid-induced HSOS (PA-HSOS) receiving hepatic venous pressure gradient (HVPG) measurement and transjugular intrahepatic portosystem shunt (TIPS) were retrospectively collected and matched with those of patients with virus- or alcohol-related cirrhosis as a cirrhosis group. Pearson’s correlation (R), intraclass correlation coefficient (ICC), scatter plots, and the Bland–Altman method were performed for agreement evaluation. Results: A total of 64 patients were analyzed (30 PA-HSOS and 34 cirrhosis groups). The correlation between WHVP and PP was moderate in the PA-HSOS group (R: 0.58, p = 0.001; ICC: 0.68, p = 0.002) but good in the cirrhosis group (R: 0.81, p < 0.001; ICC: 0.90, p < 0.001). The percentage of patients with inconsistent WHVP and PP in the two groups was 13 (43.3%) and 15 (26.5%) (p = 0.156), respectively, and an overestimation of PP was more common in the PA-HSOS group (33.3% vs. 2.9%, p = 0.004). HVPG and portal pressure gradient (PPG) consistency was poor in both groups (R: 0.51 vs. 0.26; ICC: 0.65 vs. 0.41; p < 0.05). Conclusions: WHVP in patients with PA-HSOS did not estimate PP as accurately as in patients with virus- or alcohol-related cirrhosis, which was mainly due to PP overestimation.

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“…We also used the Drum Tower Severity Scoring (DTSS) to evaluate the severity of the PA-HSOS patients and the DTSS included fibrinogen, total bilirubin, portal vein velocity, and AST as parameters. Patients with a score of 4 to 6 were defined as mild, with a score of 7 to 10 were moderate, and with a score of 11 to 16 were severe [15]. The inclusion criteria were as follows: (1) age between 18 and 80 years old, (2) clear diagnosis of PA-HSOS (according to the 'Nanjing criteria'), and (3) unresponsive to initial short-term anticoagulation therapy.…”

Section: Introductionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt improves transplant-free survival of PA-HSOS patients with no response to anticoagulation therapy——A multicenter retrospective study

Zhang

Kong

et al. 2023

Preprint

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Background & Aims Anticoagulation therapy is recommended during the acute or subacute stage for patients with pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PAHSOS). Transjugular intrahepatic portosystemic shunt (TIPS) is suggested as step-up treatment when patients have no response to anticoagulants. However, the efficacy of TIPS in patients who do not respond to anticoagulants needs more evidence. The aim of this study was to evaluate the effect of TIPS in PA-HSOS patients with no response to initial anticoagulation treatment. Methods We retrospectively enrolled PA-HSOS patients diagnosed based on the ‘Nanjing criteria’ between January 2013 and September 2020 from four hospitals, and all of them had no response to initial short-term anticoagulation therapy. Then, depending on the next treatment option, these patients were divided into the TIPS treatment group and the anticoagulation therapy group. The baseline information and clinical characteristics were collected and recorded. Liver transplant-free survival in both groups was the primary study endpoint and the risk factors for patient death were further analyzed. Results A total of 473 PA-HSOS patients from four hospitals were included in the study, and 99 patients were enrolled according to the inclusion and exclusion criteria. Of these, 63 patients were in the TIPS group and 36 were in the anticoagulation therapy group. In the anticoagulation therapy group, 25 patients received continuous anticoagulation treatment until the end of the study, and 11 patients did not respond to the prolonged anticoagulation therapy and turned to TIPS therapy halfway through treatment. There were 17 deaths during the median follow-up time of 32.5 months. The different choices of treatment (TIPS or continuous anticoagulation therapy), age, aspartate aminotransferase (AST), and serum total bilirubin (STB) were independent risk factors for predicting death. The patients in the TIPS group had a significantly higher transplant-free survival than those in the continuous anticoagulation therapy group (P=0.028). The prognosis of the mild and moderate patients treated with TIPS was better than that of the severe patients according to Drum Tower Severity Scoring (DTSS), a novel PA-HSOS severity grading criteria, while the severe patients did not show significant benefit with TIPS treatment. Conclusions TIPS treatment can improve the transplant-free survival rate in PA-HSOS patients who have failed short-term anticoagulation therapy, and patients with DTSS of mild and moderate grade could benefit from TIPS.

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Development of a Drum Tower Severity Scoring (DTSS) system for pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome

Cited by 11 publications

References 20 publications

Prognostic risk factors for patients with hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids

Prognostic risk factors for patients with hepatic sinusoidal obstruction syndrome caused by pyrrolizidine alkaloids

Agreement between Wedged Hepatic Venous Pressure and Portal Pressure in Hepatic Sinusoidal Obstruction Syndrome

Transjugular intrahepatic portosystemic shunt improves transplant-free survival of PA-HSOS patients with no response to anticoagulation therapy——A multicenter retrospective study

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