Factors Predicting Survival after Transjugular Intrahepatic Portosystemic Shunt Creation: 15 Years' Experience from a Single Tertiary Medical Center

• Published in: Journal of vascular and interventional radiology Vol. 19; no. 11; pp. 1576 - 1581
• Main Authors: Pan, Jen-Jung, MD, PhD, Chen, Chaoru, PhD, Caridi, James G., MD, Geller, Brian, MD, Firpi, Roberto, MD, Machicao, Victor I., MD, Hawkins, Irvin F., MD, Soldevila-Pico, Consuelo, MD, Nelson, David R., MD, Morelli, Giuseppe, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2008
• Subjects: Adult; Aged; Aged, 80 and over; Female; Florida - epidemiology; Humans; Male; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic - mortality; Prevalence; Radiology; Risk Assessment - methods; Risk Factors; Survival Analysis; Survival Rate; Florida; International Normalized Ratio; MELD; INR; transjugular intrahepatic portosystemic shunt; Model for End-stage Liver Disease; TIPS
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2008.07.021

Purpose This retrospective analysis was conducted to identify factors predictive of survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods Patients who underwent TIPS creation between January 1991 and December 2005 at a tertiary-care center were identified. Log-rank tests were used to compare the cumulative survival functions among groups of patients who underwent TIPS creation for various indications. Thirty-day mortality after TIPS creation was examined by logistic regression. Cox proportional-hazards analyses were performed to analyze the cumulative 90-day and 1-year survival. Selected variables such as creatinine, bilirubin, and International Normalized Ratio (INR) were assessed with respect to survival. Results The study included 352 patients, of whom 229 (65.1%) were male. The mean age at the time of TIPS creation was 53.6 years (range, 21–82 y). A Model for End-stage Liver Disease (MELD) score greater than 15 was significantly associated with poor survival ( P < .05) at 30 days, 90 days, and 1 year after TIPS creation. Independently, a serum total bilirubin level greater than 2.5 mg/dL, an INR greater than 1.4 ( P < .05), and a serum creatinine level greater than 1.2 mg/dL were predictive of poor survival. Finally, age greater than 70 years was associated with poor survival at 90 days and 1 year after TIPS creation ( P < .05). Conclusion The choice to create a TIPS in individuals whose MELD score is greater than 15 and/or whose age is greater than 70 years should involve a careful consideration of risk/benefit ratio, taking into account the finding that such patients have significantly poorer survival after TIPS creation.