1. Identifying optimal candidates for early TIPS among patients with cirrhosis and acute variceal bleeding: a multicentre observational study
- Author
-
Kewei Zhang, Jianbo Zhao, Kai Li, Minhuang Sun, Jie Yuan, Chuangye He, Hui Xue, Qifeng Peng, Zhengyu Wang, Junjiao Dong, Chunqing Zhang, Junyang Luo, Wengang Guo, Junhui Sun, Guangchuan Wang, Xiaomei Li, Ming Zhang, Xuan Zhu, Yuzheng Zhuge, Na Han, Xulong Yuan, Qiuhe Wang, Yongzhan Nie, Zhanxin Yin, Yingchun Li, Weixin Ren, Bohan Luo, Wei Bai, Daiming Fan, Guohong Han, Tianlei Yu, Luo Zuo, Jiawei Zhong, Wenguang Zhang, Zai-bo Jiang, Jing Niu, Yong Lv, Fuquan Ma, Peng-Xu Ding, and Ying Zhu
- Subjects
0301 basic medicine ,Relative risk reduction ,Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,China ,Cirrhosis ,medicine.medical_treatment ,Esophageal and Gastric Varices ,Time-to-Treatment ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Standard treatment ,Gastroenterology ,Interventional radiology ,Middle Aged ,medicine.disease ,Survival Rate ,030104 developmental biology ,Treatment Outcome ,Therapeutic endoscopy ,Portal hypertension ,030211 gastroenterology & hepatology ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Gastrointestinal Hemorrhage ,Transjugular intrahepatic portosystemic shunt - Abstract
ObjectivesEarly placement of transjugular intrahepatic portosystemic shunt (TIPS) has been shown to improve survival in high-risk patients (Child-Pugh B plus active bleeding at endoscopy or Child-Pugh C 10–13) with cirrhosis and acute variceal bleeding (AVB). However, early TIPS criteria may overestimate the mortality risk in a significant proportion of patients, and the survival benefit conferred by early TIPS in such patients has been questioned. Alternative criteria have been proposed to refine the criteria used to identify candidates for early TIPS. Nevertheless, the true survival benefit provided (or not) by early TIPS compared with standard treatment in the different risk categories has not been investigated in specifically designed comparative studies.DesignWe collected data on 1425 consecutive patients with cirrhosis and AVB who were admitted to 12 university hospitals in China between December 2010 and June 2016. Of these, 206 patients received early TIPS, and 1219 patients received standard treatment. The Fine and Gray competing risk regression model was used to compare the outcomes between the two groups that were stratified based on the currently available risk stratification systems after adjusting for liver disease severity and other potential confounders.ResultsOverall, early TIPS was associated with an 80% relative risk reduction (RRR) in mortality at 6 weeks (adjusted HR=0.20; 95% CI: 0.10 to 044; pConclusionsEarly TIPS was associated with improved survival in patients with MELD ≥19 or Child-Pugh C cirrhosis but not in patients with MELD ≤11 or Child-Pugh A cirrhosis. For MELD 12–18 or Child-Pugh B patients, future studies addressing optimal selection criteria for early TIPS remain highly warranted.
- Published
- 2018