Factores predictores de supervivencia en pacientes cirróticos con ascitis refractaria tratados con derivación portosistémica percutánea intrahepática (TIPS)

  1. Aicart Ramos, Marta
Supervised by:
  1. Agustín Albillos Martínez Director
  2. Rafael Bañares Cañizares Co-director

Defence university: Universidad de Alcalá

Fecha de defensa: 09 July 2020

Committee:
  1. Melchor Álvarez de Mon Soto Chair
  2. José Luis Calleja Panero Secretary
  3. José María Moreno Planas Committee member
Department:
  1. Medicina y Especialidades Médicas

Type: Thesis

Teseo: 152378 DIALNET lock_openTESEO editor

Abstract

Background and aims: Transjugular intrahepatic portosystemic shunt (TIPS) is increasingly used in the management of refractory ascites in cirrhosis. Controversy exists regarding the predictive factors of survival, useful for patient selection. Post-TIPS hepatic encephalopathy (HE) is the most frequent complication during the follow up. The aim was to identify predictive factors of survival and recurrent HE in patients with cirrhosis undergoing TIPS for refractory ascites. Methods: Observational, retrospective, multicentric study, that included all cirrhotic patients treated with TIPS for refractory ascites since 1992. Demographic, clinical, laboratory and hemodynamic data were collected at baseline and consecutively until dead, liver transplant or end of follow-up. Kaplan-Meier model was used to analyze survival, Cox model to identify predictive factors of survival. Covered stents were analyzed separately. Fine-Gray competing risk regression model was used to identify predictive factors of 1-year mortality or recurrent HE. Results: 198 patients were included (80% covered stents). Predictive factors of survival were age (HR 1.03 [CI 95% 1.00 – 1.06]; p=0.022), albumin (HR 0.61 [CI 95% 0.39 – 0.95]; p=0.030), serum sodium (HR 0.96 [CI 95% 0.92 – 0.99]; p=0.033) and bare stent (HR 2.05 [CI 95% 1.18 – 3.59]; p=0.011). In the covered TIPS group predictive factors of 1-year mortality/recurrent HE in multivariate analysis were age (sHR 1.05 [CI 95% 1.02 – 1.09]; p=0.001), creatinine (sHR 1.55 [CI 95% 1.23 – 1.96]; p=0.001) and serum sodium (sHR 0.94 [CI 95% 0.90 – 0.99]; p=0.011) at baseline. Based on those variables, a nomogram that identifies a priori the probability of 1-year mortality/recurrent HE was created. Conclusions: Age, creatinine and serum sodium baseline levels strongly influence 1-year survival/recurrent HE in patients with cirrhosis undergoing covered TIPS for refractory ascites. A simple nomogram identifies those patients with worse prognosis.