Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Radiological Data Acquisition
2.3. Outcomes and Definitions
2.4. TIPS Procedure and Follow-Up
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Propensity Score Matching
3.3. Overt Hepatic Encephalopathy
3.4. Mortality, Rebleeding, and Shunt Dysfunction
3.5. Changes in Liver Function and L-PUV Diameter
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameters | L-PUV (n = 27) | Control Group (n = 54) | p-Value |
---|---|---|---|
Sex (male), n (%) | 15 (55.6%) | 28 (51.9%) | 0.753 |
Age (years) | 54.0 (42.0–66.0) | 55.0 (48.0–66.5) | 0.426 |
Viral hepatitis | 15 (55.6%) | 30 (55.6%) | 1.000 |
Ascites (present), n (%) | 13 (48.1%) | 29 (53.7%) | 0.637 |
Previous diabetes, n (%) | 4 (14.8%) | 8 (14.8%) | 1.000 |
Spleen diameter (mm) | 167.0 (133.9–185.9) | 167.5 (150.4–199.5) | 0.241 |
Presence of gastric varices, n (%) | 5 (18.5%) | 7 (13.0%) | 0.422 |
Portal vein thrombosis, n (%) | 7 (25.9%) | 16 (29.6%) | 0.726 |
Total bilirubin (μmol/L) | 24.1 (16.0–39.5) | 22.4 (15.8–29.6) | 0.344 |
Albumin (g/L) | 28.6 (26.7–33.6) | 32.0 (27.5–36.1) | 0.110 |
Creatinine (μmol/L) | 59.4 (45.9–67.2) | 63.0 (53.0–70.1) | 0.233 |
Prothrombin time (S) | 16.2 (14.7–18.5) | 15.6 (14.4–17.6) | 0.370 |
International normalized ratio | 1.38 (1.23–1.60) | 1.37 (1.24–1.45) | 0.455 |
Platelet count (×109/L) | 59.0 (40.0–73.0) | 50.0 (34.0–69.3) | 0.431 |
White blood cell (×109/L) | 3.3 (2.0–7.23) | 2.6 (1.8–5.8) | 0.304 |
Child–Pugh score (points) | 7.0 (6.0–8.0) | 7.0 (6.0–8.0) | 0.236 |
Child–Pugh grade, n (%) | 0.226 | ||
A | 8 (29.6%) | 23 (42.6%) | |
B | 15 (55.6%) | 26 (48.1%) | |
C | 4 (14.8%) | 5 (9.3%) | |
MELD score (points) | 12.0 (10.0–13.0) | 11.0 (9.8–13.0) | 0.279 |
Diameter of LPV | 13.2 (10.7–14.8) | 11.1 (10.0–12.6) | 0.010 |
Diameter of RPV | 11.6 (8.1–13.0) | 11.0 (9.3–12.3) | 0.970 |
Diameter of MPV | 16.9 (13.8–20.6) | 16.4 (14.2–18.4) | 0.702 |
Esophageal variceal grade | 0.465 | ||
0 | 2 (7.4%) | 2 (3.7%) | |
I | 1 (3.7%) | 0 | |
II | 2 (7.4%) | 5 (9.3%) | |
III | 22 (81.5%) | 47 (87.0%) | |
Portal vein puncture | 0.648 | ||
LPV | 19 (70.4%) | 37 (68.5%) | |
RPV | 7 (25.9%) | 9 (16.7%) | |
MPV | 1 (3.7%) | 8 (14.8%) | |
Pre-TIPS PPG (mmHg) | 21.0 (18.0–21.0) | 21.9 (17.8–25.0) | 0.099 |
Post-TIPS PPG (mmHg) | 7.0 (6.0–9.8) | 8.0 (6.0–10.0) | 0.536 |
Diameter of balloon catheters, n (%) | 0.695 | ||
6 mm | 6 (22.2%) | 10 (18.5%) | |
8 mm | 21 (77.8%) | 44 (81.5%) | |
Duration of follow-up (months) | 22.0 (12.0–43.0) | 32.0 (20.0–47.3) | 0.111 |
Outcome | L-PUV (n = 27) | Control Group (n = 54) | p-Value |
---|---|---|---|
OHE, n (%) | 14 (51.9%) | 14 (25.9%) | 0.022 |
Episodes per patient | 0.9 ± 1.2 | 0.7 ± 1.3 | 0.426 |
Frequency of OHE | 0.056 | ||
One episode | 9 (33.3%) | 5 (9.3%) | |
More than one episode | 5 (18.5%) | 9 (16.7%) | |
Severe HE (grade III/IV) | 3 (11.1%) | 7 (13.0%) | 0.810 |
Refractory HE | 1 (3.7%) | 5 (9.3%) | 0.342 |
1-month OHE, n (%) | 4 (14.8%) | 9 (16.7%) | 0.830 |
3-month OHE, n (%) | 7 (25.9%) | 13 (24.1%) | 0.856 |
6-month OHE, n (%) | 9 (33.3%) | 13 (24.1%) | 0.382 |
1-year OHE, n (%) | 9 (33.3%) | 14 (25.9%) | 0.489 |
Death, n (%) | 4 (14.8%) | 6 (11.1%) | 0.637 |
Cause of death | |||
Gastrointestinal bleeding | 2 (7.4%) | 2 (3.7%) | |
Liver failure | 1 (3.7%) | 2 (3.7%) | |
Sepsis/pneumonia | 1 (3.7%) | 1 (1.9%) | |
Unrelated to liver disease | 0 | 1 (1.9%) | |
Rebleeding, n (%) | 3 (11.1%) | 7 (13.0%) | 0.810 |
Sources of bleeding | |||
Variceal rebleeding | 2 (7.4%) | 3 (5.6%) | |
Portal hypertensive gastropathy | 0 | 2 (3.7%) | |
Unknown | 1 (3.7%) | 2 (3.7%) | |
Shunt dysfunction, n (%) | 0 | 4 (7.4%) | 0.067 |
Variables | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
HR | 95%CI | p-Value | HR | 95%CI | p-Value | |
Total bilirubin | 1.029 | 1.001–1.058 | 0.043 | |||
L-PUV | 2.301 | 1.094–4.839 | 0.028 | 2.217 | 1.050–4.682 | 0.037 |
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Tang, H.-H.; Zhang, Z.-C.; Zhao, Z.-L.; Zhong, B.-Y.; Fan, C.; Zhu, X.-L.; Wang, W.-D. Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement. J. Clin. Med. 2023, 12, 158. https://doi.org/10.3390/jcm12010158
Tang H-H, Zhang Z-C, Zhao Z-L, Zhong B-Y, Fan C, Zhu X-L, Wang W-D. Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement. Journal of Clinical Medicine. 2023; 12(1):158. https://doi.org/10.3390/jcm12010158
Chicago/Turabian StyleTang, Hao-Huan, Zi-Chen Zhang, Zi-Le Zhao, Bin-Yan Zhong, Chen Fan, Xiao-Li Zhu, and Wei-Dong Wang. 2023. "Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement" Journal of Clinical Medicine 12, no. 1: 158. https://doi.org/10.3390/jcm12010158
APA StyleTang, H.-H., Zhang, Z.-C., Zhao, Z.-L., Zhong, B.-Y., Fan, C., Zhu, X.-L., & Wang, W.-D. (2023). Large Paraumbilical Vein Shunts Increase the Risk of Overt Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement. Journal of Clinical Medicine, 12(1), 158. https://doi.org/10.3390/jcm12010158