Hepatic venous pressure gradient (HVPG) predicts liver failure after transjugular intrahepatic portal shunt: a retrospective cohort study

Abstract

Background: Esophagogastric variceal bleeding is a serious complication of decompensated cirrhosis.Transjugular intrahepatic portal shunt (TIPS) is a salvage treatment with clear hemostatic results. However, various complications may occur after TIPS, including postoperative liver failure, and the prognosis is very poor once occurs. Liver failure is a common symptom of severe liver disease with a high mortality rate. This study investigated the incidence of liver failure after TIPS treatment for varicose bleeding.Methods: We analyzed the data of patients admitted to the First Affiliated Hospital of Soochow University between January 2013 and December 2018 with portal hypertension with an episode of acute gastroesophageal variceal bleeding. A total of 121 patients were referred to the regional liver unit for TIPS.Hepatic venous pressure gradient (HVPG) and clinical data were collected. Patients with incomplete data were excluded, and 93 patients were ultimately enrolled in the study. Primary outcomes were morbidity and hospital mortality within 4 weeks of surgery. The data were retrospectively and consecutively collected and evaluated by univariate and multivariate analyses to identify risk factors of liver failure. Results:The patients included 58 males (62.37%) and 35 females (37.63%), and the mean age was 58.43±11.85 years. The main cause was hepatitis B virus (HBV), which was found in 50.54% of patient. The overall surgical success rate was 83.87% (78/93). Of 15 treatment-failure patients, 9 (9.68%) died in hospital.Four patients died of liver failure, accounting for 44.44% of postoperative all-cause deaths. Univariate logistic regression analysis showed that only hepatic venous pressure gradient (HVPG) was an independent risk factor for post-TIPS morbidity [relative risk (RR) 1.156; 95% confidence interval (CI): 1.041 to 1.283; P=0.006]. In addition, HVPG was an independent risk factor for hospital mortality within 4 weeks (RR 1.133; 95% CI: 1.021 to 0.539; P=0.016).Conclusions: Post-TIPS liver failure is a serious complication in patients with cirrhosis. Pre-TIPS HVPG level may be used as a predictor of potential short-term postoperative adverse events.

Pre-transjugular-intrahepatic-portosystemic-shunt measurement of hepatic venous pressure gradient and its clinical application: A comparison study

“…Therefore, we assessed hyperbilirubinemia after therapy. Our results were in accordance with those of a previous study[ 24 ].…”

“…Considering the high rate of OHE in patients treated with covered TIPS placement mentioned in previous research[ 8 , 24 ], we opted for the placement of small-diameter (8 mm) stents, which can provide adequate bleeding prophylaxis and decrease the OHE rate. Regarding the patients in the low-HVPG tier, there was a trend of growth in the rate of OHE among patients treated with covered TIPS placement, and these results are in accordance with earlier findings.…”

“…The differences in encephalopathy between the two treatment groups were the largest in the first year, and this result is in accordance with that of a previous study[ 6 ]. A Chinese study proposed that the HVPG is a risk factor for liver failure after TIPS placement[ 24 ]. Therefore, we assessed hyperbilirubinemia after therapy.…”