Predictors of mortality after transjugular portosystemic shunt

Table 1 Baseline characteristics of the patient cohort

Demographics	n (%) or mean ± SD
n	418
Age (yr)	55.8 ± 11.6
Male gender	242 (57.9)
Etiologies of portal hypertension
NASH cirrhosis	132 (31.6)
Alcohol induced liver disease	105 (25.1)
HCV	105 (25.1)
Primary sclerosing cholangitis	16 (3.8)
Primary biliary cirrhosis	11 (2.6)
Others1	49 (11.7)
Patient comorbidities
Systemic hypertension	155 (37.1)
Hypothyroidism	50 (12.0)
COPD/ILD	34 (8.1)
Sleep apnea	20 (4.8)
Cardiac heart failure	18 (4.3)
Chronic kidney disease on hemodialysis	17 (4.1)
Valvular heart disease	17 (4.1)
Sarcoidosis	5 (1.2)
Splenectomy	5 (1.2)
Scleroderma	4 (1.0)
Cocaine use	4 (1.0)
HIV	1 (0.2)
Indications for TIPS
GI bleeding	182 (43.5)
Refractory ascites	157 (37.6)
Hepatic hydrothorax	51 (12.2)
Others2	28 (6.7)
Basic laboratory parameters
Serum albumin (g/dL)	2.9 ± 0.7
Serum bilirubin (mg/dL)	3.0 ± 5.4
INR	1.3 ± 0.4
Serum creatinine (mg/dL)	1.3 ± 1.1
Platelets (K/μL)	115.3 ± 77.6

¹Other etiologies of portal hypertension include hepatitis B virus, autoimmune hepatitis, alpha-1 anti-trypsin deficiency, Budd Chiari syndrome, hemochromatosis, Wilson’s disease, sarcoidosis, cystic fibrosis, biliary atresia, portal vein thrombosis, nodular regenerative hyperplasia, veno-occlusive disease and Caroli’s disease;

²Other indications for TIPS include hepatorenal syndrome, portal hypertensive gastropathy, superior mesenteric vein thrombosis, splenomegaly and the need to decrease the portal pressure prior to a surgical intervention. COPD: Chronic obstructive pulmonary disease; HIV: Human immunodeficiency virus; ILD: Interstitial lung disease; HCV: Hepatitis C virus; TIPS: Transjugular portosystemic shunt; INR: International normalized ratio.

Table 2 Multivariate linear regression model with right atrial pressure as dependent variable

Model	β	Standard error	P-value
Constant	-2.21	1.01	0.03a
MELD score	0.19	0.03	< 0.001b
Platelet count (K/μL)	-0.01	0.01	0.004b
Portal vein pressure (mmHg)	0.30	0.03	< 0.001b
Splenectomy	4.69	1.97	0.02

R = 0.55, R² = 0.3, adjusted R² = 0.29.

^aP < 0.05;

^bP < 0.01. MELD: Model for End stage Liver Disease.

Table 3 Univariate predictors of three-month survival

Variables	OR	95%CI	P
Age (per 1 yr)	1.03	1.01-1.06	0.003b
CKD on HD (yes)	5.93	1.94-18.16	0.002b
MELD (per unit change)	1.15	1.10-1.19	< 0.001b
CTP B (compared to A)	4.56	1.06-19.67	0.04a
CTP C (compare to A)	13.90	3.21-60.20	< 0.001b
RVSP (per mmHg)	1.03	1.00-1.06	0.02a
Emergent placement (yes)	2.56	1.57-4.19	< 0.001b
RA pressure before TIPS (per 1 mmHg)	1.1	1.05-1.15	< 0.001b
Portal vein pressure before TIPS (per 1 mmHg)	1.04	1.01-1.08	0.02a
RA pressure after TIPS (per 1 mmHg)	1.07	1.03-1.12	0.002b
Portal vein pressure after TIPS (per 1 mmHg)	1.06	1.02-1.10	0.006b

^aP < 0.05;

^bP < 0.01. CKD: Chronic kidney disease; CTP: Child Turcotte Pugh; HD: Hemodialysis; MELD: Model for End stage Liver Disease; OR: Odds ratio; RA: Right atrium; RVSP: Right ventricular systolic pressure; TIPS: Transjugular portosystemic pressure.

Table 4 Predictors of long term mortality in univariate Cox survival analysis

Variables	HR	95%CI	P
Age (per 1 yr)	1.02	1.01-1.03	0.001b
HCV (ETOH reference)	1.45	1.03-2.04	0.03a
Splenectomy (yes)	3.32	1.36-8.10	0.008b
CHF (yes)	1.32	1.01-1.74	0.04a
Hypothyroidism (yes)	1.20	1.00-1.42	0.04a
CKD on HD (yes)	1.56	1.17-2.06	0.002b
Portal vein pressure before TIPS (per 1 mmHg)	1.03	1.01-1.04	0.008b
RA pressure before TIPS (per 1 mmHg)	1.03	1.01-1.06	0.01a
RA pressure after TIPS (per 1 mmHg)	1.03	1.00-1.05	0.02a
MELD score (per 1 unit)	1.07	1.05-1.09	< 0.001b
Albumin (per 1 mg/dL)	0.70	0.58-0.84	< 0.001b
Billirubin (per 1 mg/dL)	1.05	1.03-1.07	< 0.001b
INR (per 1 unit change)	1.30	1.07-1.60	0.01a
Creatinine (per 1 mg/dL)	1.26	1.14-1.39	< 0.001b
CTP category B (reference A)	1.98	1.24-3.18	0.004b
CTP category C (reference A)	3.02	1.85-4.94	< 0.001b
EF echocardiogram pre TIPS (per 1% increase)	0.98	0.95-1.00	0.04a
RVSP pre TIPS (per 1 mmHg increase)	1.02	1.01-1.04	0.005b
Moderate RV dysfunction (normal RV reference)	2.84	1.18-6.85	0.02a
EF post TIPS (per 1% increase)	0.98	0.96-1.00	0.03a
RVSP post TIPS (per 1 mmHg increment)	1.02	1.01-1.04	0.01a

^aP < 0.05;

^bP < 0.01. CHF: Congestive heart failure; CKD: Chronic kidney disease; CTP: Child turcotte pugh; EF: Ejection fraction; HCV: Hepatitis C virus; HD: Hemodialysis; HR: Hazard ratio; MELD: Model for End stage Liver Disease; RA: Right atrium; RV: Right ventricle; RVSP: Right ventricular systolic pressure; TIPS: Transjugular intrahepatic portosystemic shunt; INR: International normalized ratio; ETOH: Alcoholic etiology.

Table 5 Multivariate Cox survival analysis (without including hocardiographic arameters)

Variables	HR	95%CI	P
Age (per 1 yr)	1.02	1.01-1.03	0.004b
Splenectomy (yes)	3.06	1.24-7.52	0.02a
MELD score (per 1 unit)	1.05	1.03-1.08	< 0.001b
CTP B (compared to A)	1.99	1.20-3.32	0.008b
CTP C (compared to A)	2.45	1.41-4.26	0.001b

^aP < 0.05;

^bP < 0.01. CTP: Child turcotte pugh; HR: Hazard ratio; MELD: Model for End-stage Liver Disease.