Predicting death or recurrence of portal hypertension symptoms after TIPS procedures.
Background: Accurate prediction of portal hypertension recurrence after transjugular intrahepatic portosystemic shunt (TIPS) placement will improve clinical decision-making.Purpose: To evaluate if perioperative variables could predict disease-free survival (DFS) in cirrhotic patients with portal hyp...
| Publicado en: | European Radiology Vol. 32; no. 5; pp. 3346 - 3358 |
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| Autores principales: | , , , , , , , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Springer Nature
May2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=156502814&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 156502814 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09387994 NPH jtl: European Radiology issn: 09387994 maglogo: N pubinfo: dt: May2022 vid: 32 iid: 5 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 156502814 156502814 NLM35015124 10.1007/s00330-021-08437-0 NLM35015124 156502814 ppf: 3346 ppct: 12 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Predicting death or recurrence of portal hypertension symptoms after TIPS procedures. aug: au: Sun, Shawn H. Eche, Thomas Dorczynski, Chloé Otal, Philippe Revel-Mouroz, Paul Zadro, Charline Partouche, Ephraim Fares, Nadim Maulat, Charlotte Bureau, Christophe Schwartz, Lawrence H. Rousseau, Hervé Dercle, Laurent Mokrane, Fatima-Zohra affil: Department of Radiology, Columbia University Vagellos College of Physicians and Surgeons, 10032, New York, NY, USA sug: subj: Hypertension, Portal Surgery Portasystemic Shunt, Surgical Stents Retrospective Design Liver Cirrhosis Surgery Liver Cirrhosis Complications Treatment Outcomes Middle Age Scales Middle Aged: 45-64 years ab: Background: Accurate prediction of portal hypertension recurrence after transjugular intrahepatic portosystemic shunt (TIPS) placement will improve clinical decision-making.Purpose: To evaluate if perioperative variables could predict disease-free survival (DFS) in cirrhotic patients with portal hypertension (PHT) treated with TIPS.Materials and Methods: We recruited 206 cirrhotic patients with PHT treated with TIPS, randomly assigned to training (n = 138) and validation (n = 68) sets. We recorded 7 epidemiological, 4 clinical, and 9 radiological variables. TIPS-distal end positioning (TIPS-DEP) measured the distance between the distal end of the stent and the hepatocaval junction on contrast-enhanced CT scans. In the training set, the signature was defined as the random forest for survival algorithm achieving the lowest error rate for the prediction of DFS which was landmarked 4 weeks after the TIPS procedure. In the training set, a simple to use scoring system was derived from variables selected by the signature. The primary endpoint was to assess if TIPS-DEP was associated with DFS. The secondary endpoint was to validate the scoring system in the validation set.Results: Overall, patients with TIPS-DEP ≥ 6 mm (n = 49) had a median DFS of 24.5 months vs. 72.8 months otherwise (n = 157, p = 0.004). In the training set, the scoring system was calculated by adding age ≥ 60 years old, Child-Pugh B or C, and TIPS-DEP ≥ 6 mm (1 point each) since the signature showed high DFS probability at 6.5 months post-landmark in patients that did not meet these criteria: 86%, 80%, and 78%, respectively. The hazard ratio [95 CI] between patients determined to be low-risk (< 2 points) and high-risk (≥ 2 points) was 2.30 [1.35-3.93] (p = 0.002) in the training set and 2.01 [0.94-4.32] (p = 0.072) in the validation set.Conclusion: TIPS-DEP is an actionable radiological biomarker which can be combined with age and Child-Pugh score to predict death or PHT symptom recurrence after TIPS procedure.Key Points: • TIPS-DEP measurement was the third most important but only actionable variable for predicting DFS. • TIPS-DEP < 6 mm was associated with a DFS probability of 78% at 6.5 months post-landmark. • A simple scoring system calculated using age, Child-Pugh score, and TIPS-DEP predicted DFS after TIPS. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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