Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations

Abstract Background Spontaneous portosystemic shunts (SPSS) are common in cirrhosis. Their characterization and clinical implications remain unclear. Aims To devise a system of assessment of these shunts, and assess their clinical implications Methods We retrospectively studied patients with cirrhosis who underwent imaging in a liver transplant program. A novel index was computed to assess total SPSS -the diameter of a circle having an area equivalent to the sum of the areas of all the existing shunts. This ‘SPSS equivalent diameter’ was compared with the clinical variables. Results Among 127 patients, 70% (CI95% 62–77) had SPSS, and 57% (CI95% 62–77) had multiple SPSS. The risk for SPSS was related to the severity of cirrhosis (Child-Pugh B/C vs. A: OR 2.4 CI95% 1.1–5.4) and alcoholic aetiology (OR 2.9 CI95% 1.2–7.1). The SPSS equivalent diameter was related to a history of HE, cognitive impairment (EEG/PHES) and ammonia(p 19.5 mm was a predictor of large SPSS (AUC 0.77, CI95%:0.68–0.87, p ≤ 0.001). Conclusions The SPSS equivalent diameter, a comprehensive assessment of portosystemic shunting, was associated with severity of liver disease, hyperammonemia, and cognitive dysfunction. The diameter of the inferior vena cava was a good predictor of SPSS.