1. Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model
- Author
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Francesco Vizzutti, Ciro Celsa, Vincenza Calvaruso, Marco Enea, Salvatore Battaglia, Laura Turco, Marco Senzolo, Silvia Nardelli, Roberto Miraglia, Davide Roccarina, Claudia Campani, Dario Saltini, Cristian Caporali, Federica Indulti, Stefano Gitto, Alberto Zanetto, Gabriele Di Maria, Marcello Bianchini, Maddalena Pecchini, Silvia Aspite, Chiara Di Bonaventura, Michele Citone, Tomas Guasconi, Fabrizio Di Benedetto, Umberto Arena, Fabrizio Fanelli, Luigi Maruzzelli, Oliviero Riggio, Patrizia Burra, Antonio Colecchia, Erica Villa, Fabio Marra, Calogero Cammà, Filippo Schepis, Vizzutti, Francesco, Celsa, Ciro, Calvaruso, Vincenza, Enea, Marco, Battaglia, Salvatore, Turco, Laura, Senzolo, Marco, Nardelli, Silvia, Miraglia, Roberto, Roccarina, Davide, Campani, Claudia, Saltini, Dario, Caporali, Cristian, Indulti, Federica, Gitto, Stefano, Zanetto, Alberto, Di Maria, Gabriele, Bianchini, Marcello, Pecchini, Maddalena, Aspite, Silvia, Di Bonaventura, Chiara, Citone, Michele, Guasconi, Toma, Di Benedetto, Fabrizio, Arena, Umberto, Fanelli, Fabrizio, Maruzzelli, Luigi, Riggio, Oliviero, Burra, Patrizia, Colecchia, Antonio, Villa, Erica, Marra, Fabio, Camma, Calogero, and Schepis, Filippo
- Subjects
Hepatology ,TIPS ,elderly ,cirrhosi - Abstract
Background and Aims Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in patients with cirrhosis with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (greater than or equal to 70 years) is debated, and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults. Approach and Results We prospectively enrolled 411 consecutive patients observed at four referral centers with de novo TIPS implantation for refractory ascites or secondary prophylaxis of variceal bleeding (derivation cohort) and an external cohort of 415 patients with similar indications for TIPS (validation cohort). Older adult patients in the two cohorts were 99 and 76, respectively. A cause-specific Cox competing risks model was used to predict liver-related mortality, with orthotopic liver transplant and death for extrahepatic causes as competing events. Age, alcoholic etiology, creatinine levels, and international normalized ratio in the overall cohort, and creatinine and sodium levels in older adults were independent risk factors for liver-related death by multivariable analysis. Conclusions After TIPS implantation, mortality is increased by aging, but TIPS placement should not be precluded in patients older than 70 years. In older adults, creatinine and sodium levels are useful predictors for decision making. Further efforts to update the prediction model with larger sample size are warranted.
- Published
- 2022
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