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Prediction of Mortality and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement: Baseline and Longitudinal Body Composition Measurement.
- Source :
-
Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2024 May; Vol. 35 (5), pp. 648-657.e1. Date of Electronic Publication: 2024 Jan 18. - Publication Year :
- 2024
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Abstract
- Purpose: To investigate effects of baseline and early longitudinal body composition changes on mortality and hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).<br />Materials and Methods: This is a case-control study with analysis of a TIPS registry (1995-2020) including data from patients with cirrhosis with computed tomography (CT) scans obtained within 1 month before and 3 months after TIPS. Core muscle area (CMA), macroscopic subcutaneous adipose tissue (mSAT), macroscopic visceral adipose tissue (mVAT) area, and muscle adiposity index (MAI) on CT were obtained. Multipredictor Cox proportional hazards models were used to assess the effect of body composition variables on mortality or HE.<br />Results: In total, 280 patients (158 men; median age, 57.0 years; median Model for End-stage Liver Disease-sodium [MELD-Na] score, 14.0) were included. Thirty-four patients had post-TIPS imaging. Median baseline CMA was 68.3 cm <superscript>2</superscript> (interquartile range, 57.7-83.5 cm <superscript>2</superscript> ). Patients with higher baseline CMA had decreased risks of mortality (hazard ratio [HR]: 0.82; P = .04) and HE (HR: 0.82; P = .009). It improved prediction of mortality over MELD-Na and post-TIPS right atrial pressure alone (confidence interval = 0.729). An increase in CMA (HR: 0.60; P = .043) and mSAT (HR: 0.86; P = .022) or decrease in MAI (HR: 1.50; P = .049) from before to after TIPS was associated with a decreased risk of mortality. An increase in mSAT was associated with an increased risk of HE (HR: 1.11; P = .04).<br />Conclusions: CMA on CT scan 1 month before TIPS placement predicts mortality and HE in patients with cirrhosis. Changes in body composition on CT measured 3 months after TIPS placement independently predict mortality and HE.<br /> (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Middle Aged
Risk Factors
Risk Assessment
Aged
Time Factors
Treatment Outcome
Adiposity
Body Composition
Retrospective Studies
Tomography, X-Ray Computed
Case-Control Studies
Portasystemic Shunt, Transjugular Intrahepatic adverse effects
Portasystemic Shunt, Transjugular Intrahepatic mortality
Hepatic Encephalopathy etiology
Hepatic Encephalopathy mortality
Hepatic Encephalopathy diagnostic imaging
Hepatic Encephalopathy physiopathology
Predictive Value of Tests
Registries
Liver Cirrhosis mortality
Liver Cirrhosis diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1535-7732
- Volume :
- 35
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of vascular and interventional radiology : JVIR
- Publication Type :
- Academic Journal
- Accession number :
- 38244917
- Full Text :
- https://doi.org/10.1016/j.jvir.2024.01.012