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Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model

Authors :
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
Schepis, Filippo
Source :
Hepatology. 77:476-488
Publication Year :
2022
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2022.

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.

Subjects

Subjects :
Hepatology
TIPS
elderly
cirrhosi

Details

ISSN :
02709139
Volume :
77
Database :
OpenAIRE
Journal :
Hepatology
Accession number :
edsair.doi.dedup.....cdbb0cec6cc7292c115fffc8df88dc01
Full Text :
https://doi.org/10.1002/hep.32704