Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients.
Chronic Disease
Clinical Decision Rules
Elasticity Imaging Techniques
Female
Follow-Up Studies
Hepatic Encephalopathy
/ etiology
Humans
Liver Cirrhosis
/ complications
Male
Portal Vein
/ abnormalities
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Vascular Malformations
/ complications
Collaterals
Hepatic encephalopathy
Liver imaging
Portal hypertension
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
21
10
2020
revised:
29
11
2020
accepted:
17
12
2020
pubmed:
9
1
2021
medline:
12
2
2022
entrez:
8
1
2021
Statut:
ppublish
Résumé
The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated. To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation. This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome. SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129-6.664]. During a follow-up of 37 (20-63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259-4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016-7.070) and multiple (SHR:3.832; 95%-IC: 2.004-7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521-4.569). The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.
Sections du résumé
BACKGROUND
BACKGROUND
The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated.
AIMS
OBJECTIVE
To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation.
METHODS
METHODS
This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome.
RESULTS
RESULTS
SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129-6.664]. During a follow-up of 37 (20-63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259-4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016-7.070) and multiple (SHR:3.832; 95%-IC: 2.004-7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521-4.569).
CONCLUSIONS
CONCLUSIONS
The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.
Identifiants
pubmed: 33414086
pii: S1590-8658(20)31195-6
doi: 10.1016/j.dld.2020.12.114
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
103-110Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.