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Digestive Diseases and Sciences

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15.02.2020 | Original Article

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

verfasst von: Paris Charilaou, Kalpit Devani, Romela Petrosyan, Chakradhar Reddy, Nikolaos Pyrsopoulos

Erschienen in: Digestive Diseases and Sciences | Ausgabe 11/2020

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Abstract

Background

It has been reported that transjugular intrahepatic portosystemic shunting (TIPS) might be utilized as a salvage option for hepatorenal syndrome (HRS), while randomized controlled trials are pending and real-world contemporary data on inpatient mortality is lacking.

Methods

We conducted an observational retrospective cohort study from the National Inpatient Sample from 2005 to 2014. We included all adult patients admitted with HRS and cirrhosis, using ICD 9-CM codes. We excluded cases with variceal bleeding, Budd–Chiari, end-stage renal disease, liver transplant and transfers to acute-care facilities. TIPS’ association with inpatient mortality was assessed using multivariable mixed-effects logistic regression, as well as exact-matching, thus mitigating for TIPS selection bias. The exact-matched analysis was repeated among TIPS-only versus dialysis-only patients.

Results

A total of 79,354 patients were included. Nine hundred eighteen (1.2%) underwent TIPS. Between TIPS and non-TIPS groups, mean age (58 years) and gender (65% males) were similar. Overall mortality was 18% in TIPS and 48% in dialysis-only cases (n = 10,379; 13.1%). Ninety six (10.5%) TIPS patients underwent dialysis. In-hospital mortality in TIPS patients was twice less likely than in non-TIPS patients (adjusted odds ratio [aOR] = 0.43, 95% CI 0.30–0.62; p < 0.001), with similar results in matched analysis [exact-matched (em) OR = 0.39, 95% CI 0.17–0.89; p < 0.024; groups = 96; unweighted n = 463]. Head-to-head comparison showed that TIPS-only patients were 3.3 times less likely to succumb inpatient versus dialysis-only patients (contrast aOR = 0.31, 95% CI 0.20–0.46; p < 0.001), with similar findings post-matching (emOR = 0.22, 95% CI 0.15–0.33; p < 0.001; groups = 54, unweighted n = 1457).

Conclusions

Contemporary, real-world data reveal that TIPS on its own, and when compared to dialysis, is associated with decreased inpatient mortality when utilized in non-bleeders-HRS patients. Further randomized studies are needed to establish the long-term benefit of TIPS in these patients.

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Titel: Inpatient Mortality Benefit with Transjugular Intrahepatic Portosystemic Shunt for Hospitalized Hepatorenal Syndrome Patients
verfasst von: Paris Charilaou
Kalpit Devani
Romela Petrosyan
Chakradhar Reddy
Nikolaos Pyrsopoulos
Publikationsdatum: 15.02.2020
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 11/2020
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-020-06136-2

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

Abstract

Background

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Conclusions

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