Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis.

Adult Aged Aged, 80 and over Ascites / etiology Clinical Decision-Making / methods Esophageal and Gastric Varices / complications Female Follow-Up Studies Gastrointestinal Hemorrhage / etiology Hepatic Encephalopathy / etiology Hospitals, University Humans Hypertension, Portal / complications Kaplan-Meier Estimate Liver Cirrhosis / complications Male Middle Aged Retrospective Studies Risk Assessment / methods Severity of Illness Index

ACLF Acute decompensation Acute-on-chronic liver failure Ascites Cirrhosis Computed tomography Hepatic encephalopathy Liver Portal hypertension SPSS Spontaneous portosystemic shunt TIPS

Journal

Journal of hepatology

ISSN: 1600-0641

Titre abrégé: J Hepatol

Pays: Netherlands

ID NLM: 8503886

Informations de publication

Date de publication:
06 2020

Historique:

received: 19 07 2019

revised: 12 12 2019

accepted: 21 12 2019

pubmed: 19 1 2020

medline: 9 11 2021

entrez: 19 1 2020

Statut: ppublish

Résumé

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. 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. 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 mm This study suggests that TSA >83 mm 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.

Sections du résumé

BACKGROUND & AIMS

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 mm

CONCLUSION

This study suggests that TSA >83 mm

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.

Identifiants

DOI: 10.1016/j.jhep.2019.12.021 PMID: 31954206

pubmed: 31954206

pii: S0168-8278(20)30012-X

doi: 10.1016/j.jhep.2019.12.021

pii:

doi:

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

1140-1150

Investigateurs

Sergi Quiroga (S)

Dominic Yu (D)

Luis Téllez (L)

Mattias Mandorfer (M)

Juan Carlos Garcia-Pagan (JC)

Claudia Berbel (C)

José Ferrusquia (J)

Michel Ble (M)

Mari Angeles Garcia-Criado (MA)

Ernest Belmonte (E)

Michael Ney (M)

Cristina Margini (C)

Stefania Casu (S)

Giuseppe Murgia (G)

Christiane Ludwig (C)

Franz Stangl (F)

Commentaires et corrections

Type : CommentIn

Informations de copyright

Déclaration de conflit d'intérêts

Conflict of Interest MP Sponsored lectures: Gore; AZ Sponsored lectures: Gilead, Abbvie, Norgine, Grifols, Bayer, Gore, BMS; AD Sponsored lectures: Bayer; WL Grants: Boston Scientific, Consultant: Boston Scientific, Abbvie, Gilead, Norgine, Gore; VLM Grants: Gilead Sciences research Scholar Program, Consultant: Gore, Sponsored lectures (National or International): Gore, Abbvie, Alfa-sigma; CR Grant: Schweine Stiftung; VHG Sponsored lectures (National or International): GORE; TR Grants: Abbvie, Boehringer Ingelheim, Gilead, MSD, Philips Healthcare, Gore; Consultant: Abbvie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, Siemens; Sponsored lectures (National or International): Abbvie, Gilead, Gore, Intercept, Roche, MSD; AA Grants: Gilead Sciences, Consultant: AbbVie, Gilead Sciences, Gore, Griffols, Intercept Pharmaceuticals, Pfizer and Merck & Co., Sponsored lectures (National or International): AbbVie, Gilead Sciences, Gore, Griffols, Intercept Pharmaceuticals, Pfizer and Merck & Co.; EAT Consultant: Pfizer, Intercept, Gilead, Promethera, Astra Zeneca; JT Grants: Gore, Consultant: Martins Pharma, Ironwood, Gore, Alexion, BMS, Grifols, Sequana Medicals, Versantis, Sponsored lectures (National or International): Gilead, Gore, Alexion, BMS, Grifols, Sequana Medicals, Norgine, Intercept. Please refer to the accompanying ICMJE disclosure forms for further details.