Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival

Standard

Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival. / Piecha, Felix; Radunski, Ulf K; Ozga, Ann-Kathrin; Steins, David; Drolz, Andreas; Horvatits, Thomas; Spink, Clemens; Ittrich, Harald; Benten, Daniel; Lohse, Ansgar W; Sinning, Christoph; Kluwe, Johannes.

In: JHEP reports (Online), Vol. 1, No. 2, 08.2019, p. 90-98.

Research output: SCORING: Contribution to journalSCORING: Journal articlesResearchpeer-review

Harvard

Piecha, F, Radunski, UK, Ozga, A-K, Steins, D, Drolz, A, Horvatits, T, Spink, C, Ittrich, H, Benten, D, Lohse, AW, Sinning, C & Kluwe, J 2019, 'Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival', JHEP reports (Online), vol. 1, no. 2, pp. 90-98. https://doi.org/10.1016/j.jhepr.2019.04.001

APA

Piecha, F., Radunski, U. K., Ozga, A-K., Steins, D., Drolz, A., Horvatits, T., Spink, C., Ittrich, H., Benten, D., Lohse, A. W., Sinning, C., & Kluwe, J. (2019). Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival. JHEP reports (Online), 1(2), 90-98. https://doi.org/10.1016/j.jhepr.2019.04.001

Vancouver

Piecha F, Radunski UK, Ozga A-K, Steins D, Drolz A, Horvatits T et al. Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival. JHEP reports (Online). 2019 Aug;1(2):90-98. https://doi.org/10.1016/j.jhepr.2019.04.001

Bibtex

@article{e8a2ad86013545ae94ce8af7d333d163,
title = "Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival",
abstract = "Background & Aims: Refractory ascites is the main reason for the implantation of a transjugular intrahepatic portosystemic shunt (TIPS) in liver cirrhosis, but ascites control by TIPS fails in a relevant proportion of cases. Here, we investigated whether routine parameters pre-TIPS can predict persistent ascites after TIPS implantation and whether persistent ascites predicts long-term clinical outcome.Methods: A detailed retrospective analysis of 128 patients receiving expanded polytetrafluoroethylene-covered stents for the treatment of refractory ascites was performed. Persistent ascites post-TIPS was defined as the prolonged need for paracentesis >3 months after TIPS. The influence of demographics, laboratory results, pre-TIPS heart and liver ultrasound results, and invasive hemodynamic parameters on persistent ascites was evaluated by univariable and multivariable logistic regression. Predictors of the composite endpoint liver transplantation/death were analyzed using a multivariable Cox regression.Results: Ascites control post-TIPS was achieved in 95/128 patients (74%), whereas ascites remained persistent in 33/128 cases (26%). On multivariable analysis, a lower paracentesis frequency pre-TIPS (odds ratio 1.672; 95% CI 1.253-2.355) and lower baseline creatinine levels (odds ratio 2.640; CI 1.201-6.607) were associated with ascites control. Patients with persistent ascites post-TIPS had and impaired transplant-free survival (median 10.0 vs. 25.8 months), for which persistent ascites was the only independent predictor (hazard ratio 5.654; CI 3.019-10.59).Conclusion: TIPS-placement in patients with lower paracentesis frequency and creatinine levels is associated with superior ascites control. Thus, TIPS implantation should be considered in moderate decompensation and not as a last resort. Persistent ascites post-TIPS seems to be the only predictor of liver transplantation and death.Lay summary: The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites should be considered in patients with moderate decompensation and not as a last resort, as lower paracentesis frequency and creatinine levels pre-TIPS are associated with superior ascites control. In turn, failure to control ascites seems to be the only predictor of liver transplantation and death.",
author = "Felix Piecha and Radunski, {Ulf K} and Ann-Kathrin Ozga and David Steins and Andreas Drolz and Thomas Horvatits and Clemens Spink and Harald Ittrich and Daniel Benten and Lohse, {Ansgar W} and Christoph Sinning and Johannes Kluwe",
note = "{\textcopyright} 2019 The Authors.",
year = "2019",
month = aug,
doi = "10.1016/j.jhepr.2019.04.001",
language = "English",
volume = "1",
pages = "90--98",
number = "2",

}

RIS

TY - JOUR

T1 - Ascites control by TIPS is more successful in patients with a lower paracentesis frequency and is associated with improved survival

AU - Piecha, Felix

AU - Radunski, Ulf K

AU - Ozga, Ann-Kathrin

AU - Steins, David

AU - Drolz, Andreas

AU - Horvatits, Thomas

AU - Spink, Clemens

AU - Ittrich, Harald

AU - Benten, Daniel

AU - Lohse, Ansgar W

AU - Sinning, Christoph

AU - Kluwe, Johannes

N1 - © 2019 The Authors.

PY - 2019/8

Y1 - 2019/8

N2 - Background & Aims: Refractory ascites is the main reason for the implantation of a transjugular intrahepatic portosystemic shunt (TIPS) in liver cirrhosis, but ascites control by TIPS fails in a relevant proportion of cases. Here, we investigated whether routine parameters pre-TIPS can predict persistent ascites after TIPS implantation and whether persistent ascites predicts long-term clinical outcome.Methods: A detailed retrospective analysis of 128 patients receiving expanded polytetrafluoroethylene-covered stents for the treatment of refractory ascites was performed. Persistent ascites post-TIPS was defined as the prolonged need for paracentesis >3 months after TIPS. The influence of demographics, laboratory results, pre-TIPS heart and liver ultrasound results, and invasive hemodynamic parameters on persistent ascites was evaluated by univariable and multivariable logistic regression. Predictors of the composite endpoint liver transplantation/death were analyzed using a multivariable Cox regression.Results: Ascites control post-TIPS was achieved in 95/128 patients (74%), whereas ascites remained persistent in 33/128 cases (26%). On multivariable analysis, a lower paracentesis frequency pre-TIPS (odds ratio 1.672; 95% CI 1.253-2.355) and lower baseline creatinine levels (odds ratio 2.640; CI 1.201-6.607) were associated with ascites control. Patients with persistent ascites post-TIPS had and impaired transplant-free survival (median 10.0 vs. 25.8 months), for which persistent ascites was the only independent predictor (hazard ratio 5.654; CI 3.019-10.59).Conclusion: TIPS-placement in patients with lower paracentesis frequency and creatinine levels is associated with superior ascites control. Thus, TIPS implantation should be considered in moderate decompensation and not as a last resort. Persistent ascites post-TIPS seems to be the only predictor of liver transplantation and death.Lay summary: The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites should be considered in patients with moderate decompensation and not as a last resort, as lower paracentesis frequency and creatinine levels pre-TIPS are associated with superior ascites control. In turn, failure to control ascites seems to be the only predictor of liver transplantation and death.

AB - Background & Aims: Refractory ascites is the main reason for the implantation of a transjugular intrahepatic portosystemic shunt (TIPS) in liver cirrhosis, but ascites control by TIPS fails in a relevant proportion of cases. Here, we investigated whether routine parameters pre-TIPS can predict persistent ascites after TIPS implantation and whether persistent ascites predicts long-term clinical outcome.Methods: A detailed retrospective analysis of 128 patients receiving expanded polytetrafluoroethylene-covered stents for the treatment of refractory ascites was performed. Persistent ascites post-TIPS was defined as the prolonged need for paracentesis >3 months after TIPS. The influence of demographics, laboratory results, pre-TIPS heart and liver ultrasound results, and invasive hemodynamic parameters on persistent ascites was evaluated by univariable and multivariable logistic regression. Predictors of the composite endpoint liver transplantation/death were analyzed using a multivariable Cox regression.Results: Ascites control post-TIPS was achieved in 95/128 patients (74%), whereas ascites remained persistent in 33/128 cases (26%). On multivariable analysis, a lower paracentesis frequency pre-TIPS (odds ratio 1.672; 95% CI 1.253-2.355) and lower baseline creatinine levels (odds ratio 2.640; CI 1.201-6.607) were associated with ascites control. Patients with persistent ascites post-TIPS had and impaired transplant-free survival (median 10.0 vs. 25.8 months), for which persistent ascites was the only independent predictor (hazard ratio 5.654; CI 3.019-10.59).Conclusion: TIPS-placement in patients with lower paracentesis frequency and creatinine levels is associated with superior ascites control. Thus, TIPS implantation should be considered in moderate decompensation and not as a last resort. Persistent ascites post-TIPS seems to be the only predictor of liver transplantation and death.Lay summary: The insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites should be considered in patients with moderate decompensation and not as a last resort, as lower paracentesis frequency and creatinine levels pre-TIPS are associated with superior ascites control. In turn, failure to control ascites seems to be the only predictor of liver transplantation and death.

U2 - 10.1016/j.jhepr.2019.04.001

DO - 10.1016/j.jhepr.2019.04.001

M3 - SCORING: Journal articles

C2 - 32039356

VL - 1

SP - 90

EP - 98

IS - 2

ER -