Individualized Portal Pressure Gradient Threshold Based on Liver Function Categories in Preventing Rebleeding After TIPS

Author:

Xia Yifu1,Tie Jun2,Wang Guangchuan3,Zhuge Yuzheng4,Wu Hao5,Xue Hui6,Xu Jiao7,Zhang Feng4,Zhao Lianhui8,Huang Guangjun3,Zhang Mingyan3,Wei Bo5,Li Peijie6,Wu Wei9,Chen Chao10,Tang Chengwei5,Zhang Chunqing11

Affiliation:

1. Shandong University School of Medicine: Shandong University Cheeloo College of Medicine

2. Air Force Medical University Xijing Hospital: Xijing Hospital

3. Shandong Provincial Hospital Affiliated to Shandong First Medical University: Shandong Provincial Hospital

4. Nanjing Drum Tower Hospital: Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital

5. West China School of Medicine: Sichuan University West China Hospital

6. Xi'an Jiaotong University Medical College First Affiliated Hospital

7. Xijing Hospital Department of Liver Diseases and Digestive Interventional Radiology

8. Shandong University Affiliated Hospital: Shandong Provincial Hospital

9. Wenzhou Medical College First Affiliated Hospital: The First Affiliated Hospital of Wenzhou Medical University

10. The First Affiliated Hospital of Wenzhou Medical University

11. Provincial Hospital Affiliated to Shandong University

Abstract

Abstract Background: The evidence in Portal pressure gradient (PPG) < 12 mmHg after transjugular intrahepatic portosystemic shunt (TIPS) for preventing rebleeding mostly comes from observations in uncovered stents era. Moreover, association between Child–Pugh classes and post-TIPS hepatic encephalopathy (HE) has indicated that tolerance of PPG reduction depends on liver function. This study aimed to investigate the optimal PPG for covered TIPS and explore the optimal threshold tailored to the Child–Pugh classes to find individualized PPG to balance rebleeding and overt HE. Methods: This multicenter retrospective study analyzed rebleeding, OHE, and mortality of patients associated with post-TIPS PPGs (8, 10, 12, and 14 mmHg) in the entire cohort and among different Child–Pugh classes. Propensity score matching (PSM) and competing risk analyses were performed for sensitivity analyses. Results: We included 2100 consecutively screened patients undergoing TIPS. In all patients, PPG < 12 mmHg reduced rebleeding after TIPS (P = 0.022). In Child–Pugh class A, none of the PPG thresholds were discriminative of clinical outcomes. In Child–Pugh class B, 12 mmHg (P = 0.022) and 14 mmHg (P = 0.037) discriminated rebleeding, but 12 mmHg showed a higher net benefit. In Child–Pugh class C, PPG < 14 mmHg had a lower rebleeding incidence (P = 0.017), and exhibited more net benefit than 12 mmHg. Conclusion: Different PPG standards may be required for patients with different liver function categories. A PPG threshold < 12 mmHg might be suitable for patients in Child–Pugh class B, while < 14 mmHg might be optimal for patients in Child–Pugh class C.

Publisher

Research Square Platform LLC

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3