Inpatient Mortality Benefit with Transjugular Intrahepatic Portosystemic Shunt for Hospitalized Hepatorenal Syndrome Patients

Charilaou, Paris; Devani, Kalpit; Petrosyan, Romela; Reddy, Chakradhar; Pyrsopoulos, Nikolaos

doi:10.1007/s10620-020-06136-2

Cited by 29 publications

(22 citation statements)

References 29 publications

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“…Furthermore, abdominal paracentesis may have led to the diagnosis and treatment for spontaneous bacterial peritonitis[ 45 ]. The use of TIPS in patients with HRS remains controversial, although there is increasing data suggesting there may be benefit[ 24 , 29 ]. According to current best practice recommendations, the presence of HRS is not an absolute contraindication for TIPS and the presence of other indications, such as ascites, should guide decision making[ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent decades, there have been significant advances in knowledge, treatment, and optimal management of patients with HRS[ 1 , 7 - 17 , 22 - 24 ]. While terlipressin, a synthetic vasopressin analog with predominant vasopressin 1A receptor effect[ 25 ], has been used to treat HRS in many Asian and European countries, it is currently not yet available in the United States for the treatment of HRS[ 1 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

Kaewput¹,

Dumancas²,

Kanduri³

et al. 2021

WJG

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BACKGROUND Hepatorenal syndrome (HRS) is a life-threatening condition among patients with advanced liver disease. Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited. AIM To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States. METHODS We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014 (weighted sample of 23973 admissions). The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality. We estimated odds ratios from multi-level mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality. RESULTS Overall hospital mortality was 32%. Hospital mortality decreased from 44% in 2005 to 24% in 2014 ( P < 0.001), while there was an increase in the rate of liver transplantation ( P = 0.02), renal replacement therapy ( P < 0.001), length of hospital stay ( P < 0.001), and hospitalization cost ( P < 0.001). On multivariable analysis, older age, alcohol use, coagulopathy, neurological disorder, and need for mechanical ventilation predicted higher hospital mortality, whereas liver transplantation, transjugular intrahepatic portosystemic shunt, and abdominal paracentesis were associated with lower hospital mortality. CONCLUSION Although there was an increase in resource utilizations, hospital mortality among patients admitted for HRS significantly improved. Several predictors for hospital mortality were identified.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

Kaewput¹,

Dumancas²,

Kanduri³

et al. 2021

WJG

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“…The use of TIPS in patients with HRS-AKI remains controversial since a majority of these patients are sick at presentation with sepsis or acute decompensation. A recent retrospective cohort study in HRS patients showed TIPS is a relatively safe, bridging therapeutic option in patients who underwent TIPS in comparison to patients who received dialysis[ 153 ]. Decreased recurrence of ascites and increased incidence of HE in the TIPS group was seen in a small randomized study where they compared patients with Type 2 HRS (HRS non-AKI) who underwent TIPS with another group of patients receiving paracentesis plus albumin[ 81 ].…”

Section: Hhmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Rajesh

George

Philips

et al. 2020

WJG

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More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding, the transjugular intrahepatic portosystemic shunt (TIPS) procedure continues to remain a focus of intense clinical and biomedical research. By the impressive reduction in portal pressure achieved by this intervention, coupled with its minimally invasive nature, TIPS has gained increasing acceptance in the treatment of complications of portal hypertension. The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy. Moreover, the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions, which was occasionally severe. While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents, hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS. It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS. The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax, portal hypertensive gastropathy, ectopic varices, hepatorenal and hepatopulmonary syndromes, non-tumoral portal vein thrombosis and chylous ascites. It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality. The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.

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“…Song and colleagues showed that TIPS is associated with decreased serum creatinine, with possible survival benefits in HRS patients [35]. Charilaou and colleagues have performed a retrospective analysis of the National Inpatient Sample database from 2005 to 2014 using ICD-9-CM codes to identify patients with HRS who received treatment with TIPS, compared the outcome of these patients with those who received dialysis or no TIPS, they found that TIPS is more superior associated with reducing inpatient mortality rate [36].…”

Section: Transjugular Intrahepatic Portosystemic Shunt (Tips)mentioning

confidence: 99%

Clinical Practice of Hepatorenal Syndrome: A Brief Review on Diagnosis and Management

Rendy¹,

Febyan²,

Wetarini³

2021

EJMED

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The hepatorenal syndrome is one of various potential causes of acute kidney injury in patients with decompensated liver disease. Hepatorenal syndrome is diagnosed based on reducing kidney function without any evidence of intrinsic kidney disease, including proteinuria, hematuria, or abnormal kidney ultrasonography. Clinically, hepatorenal syndrome is divided into two types named type 1 and type 2. The most favorable therapy for HRS cases is liver transplantation; however, only a few undergo this procedure due to the high mortality. Other modalities for hepatorenal syndrome therapy are pharmacology and non-pharmacology approaches. The purpose of management HRS is to optimize and stabilize the patient until an organ transplant available. This review aims to discuss the underlying pathophysiology and demonstrate the diagnostic approach of hepatorenal syndrome to determine the most appropriate therapeutic measures in clinical practice. The clinicians must be aware of management principles of hepatorenal syndrome to improve the quality of care for patients and optimize the clinical conditions.

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Inpatient Mortality Benefit with Transjugular Intrahepatic Portosystemic Shunt for Hospitalized Hepatorenal Syndrome Patients

Cited by 29 publications

References 29 publications

In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample

Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Clinical Practice of Hepatorenal Syndrome: A Brief Review on Diagnosis and Management

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