Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) placement is effective in the treatment of complications of portal hypertension. This study evaluated the predictors of mortality in a group of cirrhotic patients with advanced liver disease after placement of TIPS. Methods: A retrospective analysis of all patients undergoing TIPS placement over a 2 1/2-year period was undertaken. Results: Fifty-six patients had TIPS placement for variceal hemorrhage, 49 for refractory ascites, and 24 for hepatic hydrothorax (total, 129). Of 21 variables available before TIPS placement, variceal hemorrhage requiring emergent TIPS placement (relative risk [RR], 37.5; 95% confidence interval [CI], 5.4-259) and bilirubin concentration >3.0 mg/dL (RR, 5.4; 95% CI, 1.4-10.2) were independent predictors of 30-day mortality. Variceal hemorrhage requiring emergent TIPS placement (hazard ratio [HR], 5.1, 95% CI, 2.2-9.1), alanine aminotransferase level >100 IU/L (HR, 2.5; 95% CI, 1.2-5.5), bilirubin level >3.0 mg/dL (HR, 2.6; 95% CI, 1.1-4.6), and pre-TIPS encephalopathy unrelated to bleeding (HR, 2.2; 95% CI, 1.2-4.8) independently predicted death during the follow-up period. A model was developed that separated the patients into 3 groups with significantly different survival rates. Conclusions: A clinical index consisting of 4 pre-TIPS variables can reliably predict outcome after TIPS.