Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis.
- Praktiknjo M Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- Simón-Talero M Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain.
- Römer J Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- Roccarina D Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom.
- Martínez J Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRICYS, Universidad de Alcalá, CIBERehd, Spain.
- Lampichler K Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.
- Baiges A Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERehd, Spain.
- Low G Department of Radiology, University of Alberta, Edmonton, Canada.
- Llop E Liver Unit, Hospital U. Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain.
- Maurer MH Department of Radiology, Inselspital, University of Berne, Berne, Switzerland.
- Zipprich A First Department of Internal Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
- Triolo M Medicina Interna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Donato, Università Degli Studi di Milano, San Donato Milanese (MI), Italy.
- Maleux G Department of Interventional Radiology, University Hospitals Leuven, KU Leuven, Belgium.
- Fialla AD Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
- Dam C Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
- Vidal-González J Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain.
- Majumdar A Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom.
- Picón C Department of Radiology, Hospital Universitario Ramón y Cajal, IRICYS, Universidad de Alcalá, CIBERehd, Spain.
- Toth D Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.
- Darnell A Department of Radiology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
- Abraldes JG Cirrhosis Care Clinic, University of Alberta, Edmonton, Canada.
- López M Liver Unit, Hospital U. Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain.
- Jansen C Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- Chang J Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- Schierwagen R Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany.
- Uschner F Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany.
- Kukuk G Department of Radiology, University of Bonn, Bonn, Germany.
- Meyer C Department of Radiology, University of Bonn, Bonn, Germany.
- Thomas D Department of Radiology, University of Bonn, Bonn, Germany.
- Wolter K Department of Radiology, University of Bonn, Bonn, Germany.
- Strassburg CP Department of Internal Medicine I, University of Bonn, Bonn, Germany.
- Laleman W Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
- La Mura V Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, U.O.C. Medicina Generale-Emostasi e Trombosi, Milano, Italy; Dipartimento di Scienze biomediche per la Salute and Centro di Ricerca Coordinata "A. M. e A. Migliavacca" per lo Studio e la Cura delle Malattie del Fegato, Università degli Studi di Milano, Milano, Italy.
- Ripoll C First Department of Internal Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
- Berzigotti A Hepatology, Inselspital, University of Berne, Berne, Switzerland.
- Calleja JL Liver Unit, Hospital U. Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain.
- Tandon P Cirrhosis Care Clinic, University of Alberta, Edmonton, Canada.
- Hernandez-Gea V Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERehd, Spain.
- Reiberger T Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
- Albillos A Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRICYS, Universidad de Alcalá, CIBERehd, Spain.
- Tsochatzis EA Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom.
- Krag A Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.
- Genescà J Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain. Electronic address: jgenesca@vhebron.net.
- Trebicka J Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure - EF CLIF, Barcelona, Spain; Institute for Bioengineering of Catalonia, Barcelona, Spain. Electronic address: jonel.trebicka@kgu.de.
- 2020-01-19
Published in:
- Journal of hepatology. - 2020
ACLF
Acute decompensation
Acute-on-chronic liver failure
Ascites
Cirrhosis
Computed tomography
Hepatic encephalopathy
Liver
Portal hypertension
SPSS
Spontaneous portosystemic shunt
TIPS
English
BACKGROUND & AIMS
Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis.
METHODS
In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint.
RESULTS
A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02-2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA.
CONCLUSION
This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis.
LAY SUMMARY
The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.
Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis.
METHODS
In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint.
RESULTS
A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02-2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA.
CONCLUSION
This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis.
LAY SUMMARY
The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1016/j.jhep.2019.12.021
- PMID 31954206
- Persistent URL
- https://folia.unifr.ch/global/documents/157274
Statistics
Document views: 34
File downloads:
- fulltext.pdf: 0