About 20% of patients develop cardiac decompensation within the first year after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for cardiac decompensation remain poorly defined. We aimed to evaluate predictors of cardiac decompensation after TIPS insertion in a large, well-defined cohort of patients with liver cirrhosis.234 cirrhotic patients who received a TIPS at Hannover Medical School were retrospectively followed up for one year to assess the incidence of cardiac decompensation. Echocardiographic parameters and established diagnostic criteria for cardiac impairment (e.g. by the American Society of Echocardiography/ European Association of Cardiovascular Imaging (ASE/EACVI)) were investigated for an association with cardiac decompensation in a competing risk analysis. Survival was analyzed using a multivariable cox regression analysis adjusting for Freiburg index of post-TIPS survival.Predominant TIPS indication was ascites (83%). Median age was 59 years, median MELD-score 12% and 58% were male. Overall, 41 patients (18%) developed cardiac decompensation within one year after TIPS insertion. Diastolic dysfunction according to the ASE/EACVI was diagnosed in 26% of patients at baseline and was linked to a significantly higher risk for cardiac decompensation (p = 0.025) after TIPS. When investigating individual echocardiographic baseline parameters, only pathological E/A (<0.8 or >2) was identified as a risk factor for cardiac decompensation (p = 0.015). Mortality and liver transplantation (n = 50) were significantly higher among patients who developed cardiac decompensation (HR = 5.29, p < 0.001) as well as in patients with a pathological E/A (HR = 2.34, p = 0.006). Cardiac high-risk status (44% of patients) was strongly linked to cardiac decompensation (HR = 2.93, p = 0.002) and mortality (HR = 2.24, p = 0.012).Cardiac decompensation after TIPS is a frequent and important complication and is associated with reduced survival. American Society of Echocardiography/EACVI criteria and E/A seem to be the best parameters to predict the cardiac risk in cirrhotic patients undergoing TIPS insertion.
Background and Aims Patients with decompensated liver cirrhosis and portal hypertension are characterized by a state of systemic inflammation (SI). Transjugular intrahepatic portosystemic shunt (TIPS)-insertion is an effective therapy for portal hypertension. The aim of this study was to investigate the impact of TIPS-insertion on SI.
Abstract Background and aims Hepatorenal syndrome is a major complication in patients with cirrhosis and associated with high mortality. Predictive biomarkers for therapy response are largely missing. Cytokeratin18‐based cell death markers are significantly elevated in patients with complications of chronic liver disease, but the role of these markers in patients with HRS treated with vasoconstrictors and albumin is unknown. Methods We prospectively analyzed a total of 138 patients with HRS, liver cirrhosis without HRS and acute kidney injury treated at the University Medical Center Mainz between April 2013 and July 2018. Serum levels of M30 and M65 were analyzed by ELISA and clinical data were collected. Predictive ability was assessed by Kaplan‐Meier curves, logistic regression and c‐statistic. Primary endpoint was response to therapy. Results M30 and M65 were significantly increased in patients with HRS compared to non‐HRS controls (M30: p < 0.0001; M65: p < 0.0001). Both serum markers showed predictive ability for dialysis‐ and LTX‐free survival but not overall survival. Logistic regression confirmed M30 and M65 as independent prognostic factors for response to therapy. A novel predictive score comprising bilirubin and M65 showed highest predictive ability to predict therapy response. Conclusions Serum levels of M30 and M65 can robustly discriminate patients into responders and non‐responders to terlipressin therapy with a good predictive ability for dialysis‐ and LTX‐free survival in cirrhotic patients. Cell death parameters might possess clinical relevance in patients with liver cirrhosis and HRS.
Einleitung Eine Leberzirrhose kann zu therapierefraktärem Aszites (RA) führen. Hier stellt die Anlage eines transjugulären portosystemischen Shunts (TIPS) die Therapie der ersten Wahl dar. Jedoch kann eine TIPS-Anlage nicht jedem Patienten angeboten werden, da Kontraindikationen vorliegen können. In diesen Fällen sind Patienten auf rezidivierende Parazentesen angewiesen. Eine Alternative könnte die Anlage eines permanenten, getunnelten Peritonealkatheters (PeKa) darstellen, wodurch Patienten zuhause Aszites ablassen können.
Considerate patient selection is vital to ensure the best possible outcomes after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, data regarding the impact of intrapulmonary vascular dilatations (IPVDs) or hepatopulmonary syndrome (HPS) on the clinical course after TIPS implantation is lacking. Hence, this study aimed to investigate the relevance of IPVD and HPS in patients undergoing TIPS implantation.
Zielsetzung Eine differenzierte Patientenselektion ist essenziell, um bestmögliche Resultate durch die Implantation eines transjugulären intrahepatischen portosystemischen Shunts (TIPS) zu erreichen. Die Relevanz von intrapulmonalen Shunts (IPVD) und dem hepatopulmonalen Syndrom (HPS) ist in diesem Kontext ungeklärt. Daher wurde in dieser Studie die Bedeutung von IPVD und HPS für den klinischen Verlauf von Patienten nach TIPS-Implantation untersucht.
Einleitung Eine Leberzirrhose kann zu refraktärem Aszites (RA) führen. Sollte keine Lebertransplantation möglich sein, stellt die Anlage eines transjugulären portosystemischen Shunts (TIPS) die Therapie der ersten Wahl dar. Jedoch kann dies nicht jedem Patienten angeboten werden, da Kontraindikationen vorliegen können. In solchen Fällen sind Patienten auf rezidivierende Parazentesen angewiesen. Eine Alternative könnte die Anlage eines permanenten, getunnelten Peritonealkatheter (PeKa) darstellen. Diese Studie untersucht den Verlauf von Patienten mit RA und PeKa-Anlage im Vergleich zu Patienten mit Standardbehandlung (SOC).
