Transjugular intrahepatic portosystemic shunt does not independently increase risk of death in high model for end stage liver disease patients

Erin K Spengler; Lawrence G Hunsicker; Sanam Zarei; M. Bridget Zimmerman; Michael D Voigt

doi:10.1002/hep4.1053

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Transjugular intrahepatic portosystemic shunt does not independently increase risk of death in high model for end stage liver disease patients

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Transjugular intrahepatic portosystemic shunt does not independently increase risk of death in high model for end stage liver disease patients

Erin K Spengler, Lawrence G Hunsicker, Sanam Zarei, M. Bridget Zimmerman and Michael D Voigt

Hepatology communications, Vol.1(5), pp.460-468

07/2017

DOI: 10.1002/hep4.1053

PMCID: PMC5721420

PMID: 29404473

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Abstract

Physicians often exclude patients with a model for end‐stage liver disease (MELD) score ≥ 18 from a transjugular intrahepatic portosystemic shunt (TIPS) procedure due to the concern for higher risk of death. We aimed to determine if TIPS increased the risk of death in these patients. We analyzed the interaction between TIPS and MELD in 106 patients with TIPS and 79 with intractable ascites without TIPS. We performed Cox proportional hazard regression, including both TIPS and MELD as time‐dependent covariates together with their interaction, to calculate the impact of TIPS on the risk of death associated with a high MELD score. We found a negative interaction between a high MELD score and a history of TIPS, with potentially important effect sizes. Patients with MELD scores ≥18 had a 51% lower incremental risk of death (lower risk than would be expected from the combined independent risks of MELD and needing/receiving TIPS) associated with TIPS than patients with MELD scores <18 (hazard ratio for TIPS, 0.49; 95% confidence interval, 0.10‐2.45) in the first 6 months following TIPS. There was an 80% lower incremental risk of death among patients with a MELD score ≥18 (hazard ratio for TIPS, 0.20; 95% confidence interval, 0.03‐1.23) 6 months after the TIPS procedure. Conclusion : Risk of death is associated with underlying disease severity as shown by the MELD score and the need for TIPS, and both history of TIPS and high MELD score independently increased the risk of mortality. However, the risk of death after TIPS was progressively lower than expected as the MELD score increased. ( Hepatology Communications 2017;1:460–468)

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Title: Subtitle: Transjugular intrahepatic portosystemic shunt does not independently increase risk of death in high model for end stage liver disease patients
Creators: Erin K Spengler - University of Wisconsin, School of Medicine and Public Health
Lawrence G Hunsicker - Department of Internal Medicine, The University of Iowa Hospitals and Clinics
Sanam Zarei - The University of Iowa Hospitals and Clinics
M. Bridget Zimmerman - The University of Iowa Hospitals and Clinics
Michael D Voigt - Department of Internal Medicine, The University of Iowa Hospitals and Clinics
Resource Type: Journal article
Publication Details: Hepatology communications, Vol.1(5), pp.460-468
DOI: 10.1002/hep4.1053
PMID: 29404473
PMCID: PMC5721420
NLM abbreviation: Hepatol Commun
ISSN: 2471-254X
eISSN: 2471-254X
Publisher: John Wiley and Sons Inc; Hoboken
Language: English
Date published: 07/2017
Academic Unit: Biostatistics; Internal Medicine
Record Identifier: 9983997369902771

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