Neta Gotlieb, Jonathan Brill, Oren Shibolet, Shiri Sherf-Dagan and Isaac Kori
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure for hepatic decompression and lowering of portal hypertension. The procedure is performed angiographically by inserting a metal stent between the hepatic and portal vein. Improved techniques and the expanding indications of TIPS throughout the years have made it more common. Consequently, a better prediction accuracy of its outcomes and complications is warranted. The aims of this study were to present real-life experience with the TIPS procedure and to identify novel risk factors for shortterm complications and mortality. Methods and findings: We conducted an observational, retrospective study of all patients who underwent a TIPS procedure from 2005-2017 in a single tertiary center. Data collected from the medical records included demographics, anthropometrics, co-morbidities, biochemical tests, indications and short-term (≤ 90 days) complications. Binary logistic regression analysis was conducted to determine risk factors for 90-day mortality. Results: A total of 101 patients (54% males and mean age of 55.9 ± 15.7 years) underwent technically successful TIPS insertion. The most common complications were hepatic encephalopathy (43.6%, n=44) and hepatic decompensation (17.8%, n=18). The incidence of 90-day mortality was 21.8% (n=22). Multivariate analysis revealed that older age (OR=1.061, 95% CI: 1.006-1.119), hypertension (OR=6.193, 95% CI: 1.666-23.024) and high Model for End-Stage Liver Disease (MELD) score (OR=1.167, 95% CI: 1.017-1.329) were independent and significant predictors of early post-TIPS mortality. Conclusions: Older age, hypertension and high MELD score are independent predictors of early mortality postTIPS. We recommend considering these risk factors when selecting patients for TIPS insertion.
