Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding
© 2021 by the American Association for the Study of Liver Diseases..
BACKGROUND AND AIMS: Data about the prognosis of salvage transjugular intrahepatic portosystemic shunt (TIPS) using covered stents for refractory variceal bleeding caused by portal hypertension are scarce. We aimed to assess survival and to identify predictors of mortality in these patients.
APPROACH AND RESULTS: One hundred sixty-four patients with cirrhosis from five centers treated with salvage TIPS between 2007 and 2017 were retrospectively divided into a derivation cohort (83 patients) and a validation cohort (81 patients). Comparisons were performed using the Mann-Whitney and Fischer's exact test. Six-week overall survival (OS) was correlated with variables on the day of the TIPS using Kaplan-Meier curves with log-rank test and univariate/multivariate analyses using the Cox model. Eighty-three patients were included in the derivation cohort (male, 78%; age, 55 years, alcohol-associated cirrhosis, 88%; Model for End-Stage Liver Disease [MELD], 19 [15-27]; arterial lactate, 3.7 mmol/L [2.0-8.3]). Six-week OS rate was 58%. At multivariate analysis, the MELD score (OR, 1.064; 95% CI, 1.005-1.126; P = 0.028) and arterial lactate (OR, 1.063; 95% CI, 1.013-1.114; P = 0.032) were associated with 6-week OS. Six-week OS rates were 100% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 5% in patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. The 81 patients of the validation cohort had similar MELD and arterial lactate level but lower creatinine level (94 vs 106 µmol/L, P = 0.008); 6-week OS was 67%. Six-week OS rates were 86% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 10% for patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. In the overall cohort, rebleeding rate was 15.8% at 6 weeks, and the acute-on-chronic liver failure grade (OR, 1.699; 95% CI, 1.056-1.663; P = 0.040) was independently associated with rebleeding.
CONCLUSIONS: After salvage TIPS, 6-week mortality remains high and can be predicted by MELD score and lactate. Survival rate at 6 weeks was >85% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15, while mortality was >90% for lactate ≥12 mmol/L and/or MELD score ≥ 30.
| Errataetall: |
CommentIn: Hepatology. 2021 Dec;74(6):3557-3558. - PMID 34350999 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:74 |
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| Enthalten in: |
Hepatology (Baltimore, Md.) - 74(2021), 4 vom: 10. Okt., Seite 2085-2101 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
33X04XA5AT |
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| Anmerkungen: |
Date Completed 12.01.2022 Date Revised 12.01.2022 published: Print-Electronic CommentIn: Hepatology. 2021 Dec;74(6):3557-3558. - PMID 34350999 Citation Status MEDLINE |
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| doi: |
10.1002/hep.31913 |
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| PPN (Katalog-ID): |
NLM32567986X |
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| 245 | 1 | 0 | |a Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding |
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| 500 | |a Date Completed 12.01.2022 | ||
| 500 | |a Date Revised 12.01.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Hepatology. 2021 Dec;74(6):3557-3558. - PMID 34350999 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 by the American Association for the Study of Liver Diseases. | ||
| 520 | |a BACKGROUND AND AIMS: Data about the prognosis of salvage transjugular intrahepatic portosystemic shunt (TIPS) using covered stents for refractory variceal bleeding caused by portal hypertension are scarce. We aimed to assess survival and to identify predictors of mortality in these patients | ||
| 520 | |a APPROACH AND RESULTS: One hundred sixty-four patients with cirrhosis from five centers treated with salvage TIPS between 2007 and 2017 were retrospectively divided into a derivation cohort (83 patients) and a validation cohort (81 patients). Comparisons were performed using the Mann-Whitney and Fischer's exact test. Six-week overall survival (OS) was correlated with variables on the day of the TIPS using Kaplan-Meier curves with log-rank test and univariate/multivariate analyses using the Cox model. Eighty-three patients were included in the derivation cohort (male, 78%; age, 55 years, alcohol-associated cirrhosis, 88%; Model for End-Stage Liver Disease [MELD], 19 [15-27]; arterial lactate, 3.7 mmol/L [2.0-8.3]). Six-week OS rate was 58%. At multivariate analysis, the MELD score (OR, 1.064; 95% CI, 1.005-1.126; P = 0.028) and arterial lactate (OR, 1.063; 95% CI, 1.013-1.114; P = 0.032) were associated with 6-week OS. Six-week OS rates were 100% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 5% in patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. The 81 patients of the validation cohort had similar MELD and arterial lactate level but lower creatinine level (94 vs 106 µmol/L, P = 0.008); 6-week OS was 67%. Six-week OS rates were 86% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 10% for patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. In the overall cohort, rebleeding rate was 15.8% at 6 weeks, and the acute-on-chronic liver failure grade (OR, 1.699; 95% CI, 1.056-1.663; P = 0.040) was independently associated with rebleeding | ||
| 520 | |a CONCLUSIONS: After salvage TIPS, 6-week mortality remains high and can be predicted by MELD score and lactate. Survival rate at 6 weeks was >85% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15, while mortality was >90% for lactate ≥12 mmol/L and/or MELD score ≥ 30 | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 7 | |a Lactic Acid |2 NLM | |
| 650 | 7 | |a 33X04XA5AT |2 NLM | |
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| 700 | 1 | |a Olivas, Pol |e verfasserin |4 aut | |
| 700 | 1 | |a Moga, Lucile |e verfasserin |4 aut | |
| 700 | 1 | |a Trépo, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Robic, Marie Angèle |e verfasserin |4 aut | |
| 700 | 1 | |a Ollivier-Hourmand, Isabelle |e verfasserin |4 aut | |
| 700 | 1 | |a Baiges, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Sutter, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Bouzbib, Charlotte |e verfasserin |4 aut | |
| 700 | 1 | |a Peron, Jean Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Le Pennec, Vincent |e verfasserin |4 aut | |
| 700 | 1 | |a Ganne-Carrié, Nathalie |e verfasserin |4 aut | |
| 700 | 1 | |a Garcia-Pagán, Juan Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Mallet, Maxime |e verfasserin |4 aut | |
| 700 | 1 | |a Larrue, Hélène |e verfasserin |4 aut | |
| 700 | 1 | |a Dao, Thong |e verfasserin |4 aut | |
| 700 | 1 | |a Thabut, Dominique |e verfasserin |4 aut | |
| 700 | 1 | |a Hernández-Gea, Virginia |e verfasserin |4 aut | |
| 700 | 1 | |a Nault, Jean-Charles |e verfasserin |4 aut | |
| 700 | 1 | |a Bureau, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Allaire, Manon |e verfasserin |4 aut | |
| 700 | 0 | |a Salvage TIPS Group |e verfasserin |4 aut | |
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| 700 | 1 | |a Betancourt, Fabian |e investigator |4 oth | |
| 700 | 1 | |a Garcia-Criado, Maria Angeles |e investigator |4 oth | |
| 700 | 1 | |a Magaz, Marta |e investigator |4 oth | |
| 700 | 1 | |a Métivier, Sophie |e investigator |4 oth | |
| 700 | 1 | |a Musikas, Marietta |e investigator |4 oth | |
| 700 | 1 | |a Reverter, Enric |e investigator |4 oth | |
| 700 | 1 | |a Ripoll, Enric |e investigator |4 oth | |
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