The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study

Author:

Bommena Shoma1ORCID,Mahmud Nadim2ORCID,Boike Justin R.3ORCID,Thornburg Bartley G.4,Kolli Kanti P.5ORCID,Lai Jennifer C.6ORCID,German Margarita7ORCID,Morelli Giuseppe8,Spengler Erin7,Said Adnan7ORCID,Desai Archita P.9,Junna Shilpa10,Paul Sonali11,Frenette Catherine12ORCID,Verna Elizabeth C.13,Goel Aparna14ORCID,Gregory Dyanna3,Padilla Cynthia3,VanWagner Lisa B.15ORCID,Fallon Michael B.1ORCID,

Affiliation:

1. Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Phoenix, Arizona, USA

2. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

3. Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

4. Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois, USA

5. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA

6. Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA

7. Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

8. Division of Gastroenterology, Hepatology, Department of Medicine, and Nutrition, University of Florida Health, Gainesville, Florida, USA

9. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA

10. Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA

11. Department of Internal Medicine, Section of Gastroenterology and Nutrition, The University of Chicago Medicine, Chicago, Illinois, USA

12. Department for Organ and Cell Transplantation, The Scripps Clinic, La Jolla, California, USA

13. Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians & Surgeons, New York, New York, USA

14. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA

15. Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA

Abstract

Background and Aims: Single-center studies in patients undergoing TIPS suggest that elevated right atrial pressure (RAP) may influence survival. We assessed the impact of pre-TIPS RAP on outcomes using the Advancing Liver Therapeutic Approaches (ALTA) database. Approach and Results: Total 883 patients in ALTA multicenter TIPS database from 2010 to 2015 from 9 centers with measured pre-TIPS RAP were included. Primary outcome was mortality. Secondary outcomes were 48-hour post-TIPS complications, post-TIPS portal hypertension complications, and post-TIPS inpatient admission for heart failure. Adjusted Cox Proportional hazards and competing risk model with liver transplant as a competing risk were used to assess RAP association with mortality. Restricted cubic splines were used to model nonlinear relationship. Logistic regression was used to assess RAP association with secondary outcomes. Pre-TIPS RAP was independently associated with overall mortality (subdistribution HR: 1.04 per mm Hg, 95% CI, 1.01, 1.08, p=0.009) and composite 48-hour complications. RAP was a predictor of TIPS dysfunction with increased odds of post-90-day paracentesis in outpatient TIPS, hospital admissions for renal dysfunction, and heart failure. Pre-TIPS RAP was positively associated with model for end-stage liver disease, body mass index, Native American and Black race, and lower platelets. Conclusions: Pre-TIPS RAP is an independent risk factor for overall mortality after TIPS insertion. Higher pre-TIPS RAP increased the odds of early complications and overall portal hypertensive complications as potential mechanisms for the mortality impact.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Hepatology

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