Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors

Ju Wei; Zhang BoJing; Han GuoHong

doi:10.3969/j.issn.1001-5256.2016.08.019

Issue 8

Aug. 2016

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2016 > 32(8): 1529-1533

PDF( 1555 KB)

Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors

DOI: 10.3969/j.issn.1001-5256.2016.08.019

Xijing Hospital of Digestive Diseases,Fourth Military Medical University

Received Date: 2016-05-23
Published Date: 2016-08-20

Abstract

Abstract

Objective To investigate the long- term therapeutic effect of transjugular intrahepatic portosystemic shunt( TIPS) in patients with intractable cirrhotic ascites and prognostic factors. Methods A retrospective analysis was performed for the clinical data of 57 patients with intractable cirrhotic ascites who were received TIPS in our hospital from January 2009 to June 2014. Regular telephone follow- up was performed in all patients. Laboratory testing results and abdominal ultrasound and CT findings were examined. The improvement in ascites and survival were evaluated. The χ2test was applied for comparison of categorical data between groups. The Kaplan- Meier method was used to calculate the cumulative probability of survival and other cumulative probabilities,the log- rank test was used for survival difference analysis,the Cox regression model was used to analyze prognostic factors,and the receiver operating characteristic curve( ROC) and the area under the curve( AUC) were used to determine the optimal cut- off values of prognostic factors. Results The 1- year ascites remission rate after TIPS was93%,and the 1- and 2- year survival rates were 60% and 43%,respectively. The multivariate Cox regression analysis showed that Child-Pugh score( HR = 268,95% CI: 1. 009- 1. 594,P = 0. 042) and urea nitrogen( HR = 1. 143,95% CI: 1. 034- 1. 264,P = 0. 009,) were predictive factors for 1- year survival rate after TIPS in patients with intractable cirrhotic ascites. The area under the ROC curve of Child-Pugh score was 0. 699( P = 0. 011,95% CI: 0. 558- 0. 840),and the optimal cut- off value of Child- Pugh score was 8,with a sensitivity of75% and a specificity of 67%. The Kaplan- Meier survival analysis demonstrated that the 1- year survival rates of patients with Child- Pugh scores of ≤8 and > 8 were 82% and 38%,respectively( χ2= 10. 888,P = 0. 001). Conclusion TIPS is safe and effective in the treatment of intractable ascites,and Child- Pugh score ≤8 is a predictive factor for 1- year survival rate in such patients.
- liver cirrhosis,
- ascites,
- portasystemic shunt,
- transjugular intrahepatic,
- prognosis

FullText(HTML)

References(29)

References

[1] GINS P,CRDENAS A,ARROYO V,et al.Management of cirrhosis and ascites[J].N Engl J Med,2004,350(16):1646-1654.

[2] GINS P,ANGELI P,LENZ K,et al.EASL clinical practice guidelines on the management of ascites,spontaneous bacterial peritonitis,and hepatorenal syndrome in cirrhosis[J].J Hepatol,2010,53(3):397-417.

[3] RUNYON BA.Management of adult patients with ascites due to cirrhosis:update 2012[J].Hepatology,2013:1-25.

[4]SANYAL AJ,GENNING C,REDDY KR,et al.The North American study for the treatment of refractory ascite[J].Gastroenterology,2003,124(3):634-641.

[5]LEBREC D,GIUILY N,HADENGUE A,et al.Transjugular intrahepatic portosystemic shunt:comparison with paracentesis in patients with cirrhosis and refractory ascites:a randomized trial[J].J Hepatol,1996,25(12):135-144.

[6] RSSLE M,OCHS A,GULBERG V,et al.A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites[J].N Engl J Med,2000,342(6):1701-1707.

[7]GINS P,URIZ J,CALAHORRA B,et al.Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis[J].Gastroenterology,2002,123(6):1839-1847.

[8] SALERNO F,MERLI M,RIGGIO O,et al.Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites[J].Hepatology,2004,40(8):629-635.

[9] OCHS A,ROSSLE M,HAAG K,et al.The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites[J].N Engl J Med,1995,332(5):1192-1197.

[10] SAAB S,NIETO JM,LEWIS SK,et al.TIPS versus paracentesis for cirrhotic patients with refractory ascites[J].Cochrane Database Syst Rev,2006,4(4):CD004889.

[11]WONG F,SNIDERMAN K,LIU P,et al.The mechanism of the initial natriuresis after transjugular intrahepatic portosystemic shunt[J].Gastroenterology,1997,112(3):899-907.

[12]TAN HK,JAMES PD,WONG F,et al.Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion[J].J Gastroenterol Hepatol,2015,30(2):389-395.

[13] CHUTAPUTTI A.Management of refractory ascites and hepatorenal syndrome[J].J Gastroenterol Hepatol,2002,17(4):456-461.

[14]SENZOLO M,CHOLONGITAS E,TIBBALL J,et al.Transjugular intrahepatic portosystemic shunt in the management of ascites and hepatorenal syndrome[J].Eur J Gastroenterol Hepatol,2006,18(11):1143-1150.

[15]BOYER TD.Transjugular intrahepatic portosystemic shunt:current status[J].Gastroenterology,2003,124(5):1700-1710.

[16]ALBILLOS A,BANARES R,GONZALEZ M,et al.A meta-analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites[J].J Hepatol,2005,43(6):990-996.

[17]SALERNO F,CAMMA C,ENEA M,et al.Transjugular intrahepatic portosystemic shunt for refractory ascites:a meta-analysis of individual patient data[J].Gastroenterology,2007,133(3):825-834.

[18] NARAHARA Y,KANAZAWA H,FUKUDA T,et al.Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function:a prospective randomized trial[J].J Gastroenterol,2011,46(1):78-85.

[19]BAI M,QI XS,YANG ZP,et al.TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites:an updated meta-analysis[J].World J Gastroenterol,2014,20(10):2704-2714.

[20]FORREST EH,STANLEY AJ,REDHEAD DN,et al.Clinical response after transjugular intrahepatic portosystemic stent shunt insertion for refractory ascites in cirrhosis[J].Aliment Pharmacol Ther,1996,10(5):801-806.

[21]DESCHNES M,DUFRESNE MP,BUI B,et al.Predictors of clinical response to transjugular intrahepatic portosystemic shunt(TIPS)in cirrhotic patients with refractory ascites[J].Am J Gastroenterol,1999,94(5):1361-1365.

[22]BUREAU C,MTIVIER S,D'AMICO M,et al.Serum bilirubin and platelet count:a simple predictive model for survival in patients with refractory ascites treated by TIPS[J].J Hepatol,2011,54(5):901-907.

[23]HA MEL B,GUILLAUDA O,ROMAN S,et al.Prognostic factors in patients with refractory ascites treated by transjugular intrahepatic porto-systemic shunt:from the liver to the kidney[J].Dig Liver Dis,2014,46(8):1001-1007.

[24] PARVINIAN A,BUI JT,KNUTTINEN MG,et al.Transjugular intrahepatic portosystemic shunt for the treatment of medically refractory ascites[J].Diagn Interv Radiol,2014,20(1):58-64.

[25]TAKI Y,KANAZAWA H,NARAHARA Y,et al.Predictive factors for improvement of ascites after transjugular intrahepatic portosystemic shunt in patients with refractory ascites[J].Hepatol Res,2014,44(8):871-877.

[26]SERSTT,GUSTOT T,RAUTOU PE,et al.Severe hyponatremia is a better predictor of mortality than MELDNa in patients with cirrhosis and refractory ascites[J].J Hepatol,2012,57(2):274-280.

[27]HARROD-KIM P,SAAD WE,WALDMAN D,et al.Predictors of early mortality after transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites[J].J Vasc Interv Radiol,2006,17(10):1605-1610.

[28]SANYAL AJ.Pros and cons of TIPS for refractory ascites[J].J Hepatol,2005,43(6):924-925.

[29]WU X,DING W,CAO J,et al.Clinical outcome using the fluency stent graft for transjugular intrahepatic portosystemic shunt in patients with portal hypertension[J].Am Surg,2013,79(3):305-312.

Relative Articles

[1]	Lanjing WANG, Xin YAO, Jianping QIN, Shanhong TANG. TIPS for treatment of refractory ascites in cirrhosis[J]. Journal of Clinical Hepatology, 2022, 38(11): 2606-2610. doi: 10.3969/j.issn.1001-5256.2022.11.034
[2]	Li Qiang, Zhu QingLiang, Zhang HaiLong, Deng MingMing, Hu Qing, Wang ZiJie. Characteristics of intestinal flora before and after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2020, 36(2): 333-337. doi: 10.3969/j.issn.1001-5256.2020.02.020
[3]	Guo Shuai, Han GuoHong. Safety and efficacy of transjugular intrahepatic portosystemic shunt in treatment of acute decompensated cirrhotic events in patients with acute-on-chronic liver failure[J]. Journal of Clinical Hepatology, 2020, 36(4): 818-822. doi: 10.3969/j.issn.1001-5256.2020.04.022
[4]	Zhang XiaoFeng, Zhang Wei, Yu ZhiYuan, Zhu GeYuZheng. Prognostic and risk factors for patients undergoing recanalization due to shunt dysfunction after transjugular intrahepatic portosystemic shunt[J]. Journal of Clinical Hepatology, 2020, 36(2): 338-342. doi: 10.3969/j.issn.1001-5256.2020.02.021
[5]	Yao Xin, Zhou Hao, Tang ShanHong, Xie Min, Huang Shan, Qin JianPing. Stent dysfunction after transjugular intrahepatic portosystemic shunt: Causes and countermeasures[J]. Journal of Clinical Hepatology, 2019, 35(5): 1052-1056. doi: 10.3969/j.issn.1001-5256.2019.05.023
[6]	Li Jing, Jiang Yong, Zhang Xu. Efficacy of transjugular intrahepatic portosystemic shunt versus endoscopic cyanoacrylate injection in treatment of gastric variceal bleeding: A meta-analysis[J]. Journal of Clinical Hepatology, 2019, 35(2): 349-353. doi: 10.3969/j.issn.1001-5256.2019.02.021
[7]	Zou SongLong, Xu Ying. Prognostic evaluation of transjugular intrahepatic portosystemic shunt in treatment of cirrhotic portal hypertension[J]. Journal of Clinical Hepatology, 2019, 35(1): 201-204. doi: 10.3969/j.issn.1001-5256.2019.01.044
[8]	Chen Min, Zhang Feng, Zhang Ming, Li ZhenLei, He QiBin, Mou ChengCheng, Zhong WenQi, Zhu GeYuZheng. Clinical effect of transjugular intrahepatic portosystemic shunt combined with tissue adhesive embolization in treatment of gastroesophageal variceal rebleeding in cirrhotic patients[J]. Journal of Clinical Hepatology, 2018, 34(6): 1209-1214. doi: 10.3969/j.issn.1001-5256.2018.06.016
[9]	Xu Lu, Xiao Xue, Liu JingQi, Wang Jing, Zhou JingJing, Jiang ChunMeng. Influence of covered stent versus bare stent on long-term efficacy of transjugular intrahepatic portosystemic shunt: a Meta-analysis[J]. Journal of Clinical Hepatology, 2016, 32(10): 1900-1905. doi: 10.3969/j.issn.1001-5256.2016.10.015
[10]	Xu ZhengGuo, Zhao YongBing, Zheng YuanYu, Liu En, Yang ShiMing. Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis[J]. Journal of Clinical Hepatology, 2016, 32(12): 2326-2330. doi: 10.3969/j.issn.1001-5256.2016.12.019
[11]	Ren ShuYao, Chen Hui, Lu: Yong, Wang ZhengYu, Niu Jing, Yin ZhanXin, He ChuangYe, Guo WenGang, Han GuoHong. Hepatic myelopathy after transjugular intrahepatic portosystemic shunt:natural course,survival analysis,and treatment[J]. Journal of Clinical Hepatology, 2016, 32(6): 1112-1117. doi: 10.3969/j.issn.1001-5256.2016.06.018
[12]	Lin Jing, Wei Bo, Wu Hao, Tong Huan, Tang ChengWei. Effect of antiviral therapy on prognosis of patients with decompensated hepatitis B cirrhosis undergoing transjugular intrahepatic portosystemic shunt[J]. Journal of Clinical Hepatology, 2016, 32(2): 254-258. doi: 10.3969/j.issn.1001-5256.2016.02.011
[13]	Tian Yan, Hu NaiZhong. Value of five-stage prognostic system in predicting short-term outcome of patients with liver cirrhosis[J]. Journal of Clinical Hepatology, 2015, 31(3): 387-391. doi: 10.3969/j.issn.1001-5256.2015.03.018
[14]	阿丽亚·热哈提, Shi XiuJiang, Feng Juan, Ma HaiLin, Chen Lan, 希尔娜依·阿不都黑力力, He FangPing. Influencing factors for survival after liver transplantation: a prognostic analysis of 34 cases [J]. Journal of Clinical Hepatology, 2015, 31(8): 1314-1316. doi: 10.3969/j.issn.1001-5256.2015.08.032
[15]	Zhang DanDan, Ye PeiYan, Huang YuXian, Xu GuoGuang, Zhang Yi, Li XinYan, Chen Liang. Analysis of predictive factors for rapid virologic response in treating patients with chronic hepatitis C[J]. Journal of Clinical Hepatology, 2014, 30(12): 1310-1314. doi: 10.3969/j.issn.1001-5256.2014.12.019
[16]	Zhong HuaPing, Zhou Zhi, Liao GuiLan. Analysis of early warning indicators of tuberculous peritonitis in patients with cirrhotic ascites[J]. Journal of Clinical Hepatology, 2014, 30(4): 357-359. doi: 10.3969/j.issn.1001-5256.2014.04.017
[17]	Tang ShanHong, Qin JianPing, Jiang MingDe, Ceng WeiZheng, Yao Xin, He QianWen, Tang Wen, Gu Ming. Clinical effect and safety of TIPS in treatment of portal hypertension due to alcoholic cirrhosis[J]. Journal of Clinical Hepatology, 2014, 30(2): 145-148. doi: 10.3969/j.issn.1001-5256.2014.02.012
[18]	Wu JiYuan, Zhang DongQin, Zhang HaiYue, Wang LuWen, Gong ZuoJiong. Efficacy and safety of transjugular intrahepatic portosystemic shunt versus endoscopic therapy for prevention of variceal rebleeding in patients with cirrhosis: a meta-analysis[J]. Journal of Clinical Hepatology, 2014, 30(12): 1272-1278. doi: 10.3969/j.issn.1001-5256.2014.12.010
[19]	Yin Hao, Xiao Lin, Zhan XinYu, Zhang ZeGao, Lu XiaoBo, Zhang YueXin. Prognostic factors in patients with hepatitis B- related primary liver cancer treated with transcatheter arterial chemoembolization[J]. Journal of Clinical Hepatology, 2014, 30(1): 50-54. doi: 10.3969/j.issn.1001-5256.2014.01.011
[20]	Yuan ShanShan, Han GuoHong, Bo Ming, He ChuangYe, Yin ZhanXin, Wang JianHong, Qi XingShun, Yang ZhiPing, Zhang Wei. Prognostic factors in the prediction of survival following TIPS for cirrhosis and refractory ascites[J]. Journal of Clinical Hepatology, 2011, 27(5): 525-527.

Supplements(0)

Cited By

Cited by

Periodical cited type(12)

1.	张国顺，刘超，王素颖，蒋美钰，梅冬雪，杨学慧，辛英瑛，石峥. 肝硬化门静脉高压症的治疗进展. 中国综合临床. 2024(03): 223-227 .
2.	余亚平，傅淑艳，凌红羽，苏建明，赵燕平. 基于数据挖掘技术探讨徐志瑛教授辨治肝硬化腹水的用药规律. 天津中医药大学学报. 2022(02): 157-161 .
3.	单航声，蒋明明，徐浩，张庆桥，魏宁，许伟，崔艳峰，刘洪涛，顾玉明，祖茂衡，王文亮，高志康. 改良经颈静脉肝内门体分流术治疗布-加综合征所致顽固性腹水效果分析. 介入放射学杂志. 2021(03): 235-238 .
4.	耿旭，沙俊诚，徐浩，张庆桥，魏宁，许伟，顾玉明，徐凯，祖茂衡. 广泛肝静脉闭塞性布加综合征TIPS术后肝脏体积及肝功能变化. 中华肝胆外科杂志. 2021(06): 434-437 .
5.	吴胜，唐晓明，蔡创，田宇剑，李伟，周城臣. 肝细胞癌切除术后发生大量腹水的影响因素分析. 肝脏. 2020(07): 765-767 .
6.	孙亚男，李鹏，丁惠国，张世斌，熊峰. 食管静脉曲张首次硬化剂治疗后早期再出血的危险因素. 临床肝胆病杂志. 2019(01): 92-97 . 本站查看
7.	邹松龙，胥莹. 经颈静脉肝内门体分流术治疗肝硬化门静脉高压症的预后评估. 临床肝胆病杂志. 2019(01): 201-204 . 本站查看
8.	张东旭，骆子义. 内镜下食管静脉曲张套扎术治疗研究进展. 新发传染病电子杂志. 2018(01): 54-56 .
9.	蒙冠龙，胡淑芳. 大量放腹水加白蛋白治疗肝硬化张力性腹水疗效分析. 现代医学与健康研究电子杂志. 2018(13): 22-23 .
10.	张艳飞，陈平. 经颈静脉肝内门体静脉分流术的预后研究进展. 中国微创外科杂志. 2018(05): 457-461 .
11.	张东旭，骆子义. 食管静脉曲张套扎术治疗肝硬化食管静脉曲张破裂出血的效果观察. 临床肝胆病杂志. 2017(01): 76-81 . 本站查看
12.	许钰波，王宝岩. 气针疗法配合特色药物治疗肝硬化顽固性腹水临床研究. 中医临床研究. 2017(32): 20-24 .

Other cited types(11)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (2442) PDF downloads(490)

Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors

DOI: 10.3969/j.issn.1001-5256.2016.08.019