Parvinian Ahmad, Bui James T, Knuttinen M Grace, Minocha Jeet, Gaba Ron C
University of Illinois Hospital and Health Sciences System, Department of Radiology. Chicago, IL, USA.
Ann Hepatol. 2014 Jul-Aug;13(4):411-9.
To elucidate the impact of right atrial (RA) pressure on early mortality after transjugular intrahepatic portosystemic shunt (TIPS).
In this single institution retrospective study, 125 patients (M:F = 75:50, mean age 55 years) who underwent TIPS with recorded intra-procedural RA pressures between 1999-2012 were studied. Demographic (age, gender), liver disease (Child-Pugh, Model for End Stage Liver Disease or MELD score), and procedure (indication, urgency, Stent type, portosystemic gradient or PSG reduction, baseline and post-TIPS RA pressure) data were identified, and the influence of these parameters on 30- and 90-day mortality was assessed using binary logistic regression.
TIPS were created for variceal hemorrhage (n = 55) and ascites (n = 70). Hemodynamic success rate was 99% (124/125) and mean PSG reduction was 13 mmHg. 30- and 90-day mortality rates were 18% (19/106) and 28% (29/106). Baseline and final RA pressure were significantly associated with 30- (12 vs. 15 mmHg, P = 0.021; 18 vs. 21 mmHg, P = 0.035) and 90-day (12 vs. 14 mmHg, P = 0.022; 18 vs. 20 mmHg, P = 0.024) survival on univariate analysis. Predictive usefulness of RA pressure was not confirmed in multivariate analyses. Area under receiver operator characteristic (AUROC) curve analysis revealed good pre- and post-TIPS RA pressure predictive capacity for 30- (0.779, 0.810) and 90-day (0.813, 0.788) mortality among variceal hemorrhage patients at 14.5 and 21.5 mm Hg thresholds.
Intra-procedural RA pressure may have predictive value for early post-TIPS mortality. Pre-procedure consideration and optimization of patient cardiac status may enhance candidate selection, risk stratification, and clinical outcomes, particularly in variceal hemorrhage patients.
阐明右心房（RA）压力对经颈静脉肝内门体分流术（TIPS）后早期死亡率的影响。
在这项单机构回顾性研究中，对1999年至2012年间接受TIPS且术中记录了RA压力的125例患者（男∶女 = 75∶50，平均年龄55岁）进行了研究。确定了人口统计学数据（年龄、性别）、肝脏疾病情况（Child-Pugh评分、终末期肝病模型或MELD评分）以及手术相关数据（适应证、紧急程度、支架类型、门体压力梯度或PSG降低情况、基线及TIPS术后RA压力），并使用二元逻辑回归评估这些参数对30天和90天死亡率的影响。
TIPS手术的适应证为静脉曲张出血（n = 55）和腹水（n = 70）。血流动力学成功率为99%（124/125），平均PSG降低13 mmHg。30天和90天死亡率分别为18%（19/106）和28%（29/106）。单因素分析显示，基线和最终RA压力与30天（12 vs. 15 mmHg，P = 0.021；18 vs. 21 mmHg，P = 0.035）和90天（12 vs. 14 mmHg，P = 0.022；18 vs. 20 mmHg，P = 0.024）生存率显著相关。多因素分析未证实RA压力的预测价值。受试者操作特征（AUROC）曲线分析显示，对于静脉曲张出血患者，在14.5和21.5 mmHg阈值时，TIPS术前和术后RA压力对30天（0.779，0.810）和90天（0.813，0.788）死亡率具有良好的预测能力。
术中RA压力可能对TIPS术后早期死亡率具有预测价值。术前考虑并优化患者心脏状况可能会改善候选患者的选择、风险分层及临床结局，尤其是在静脉曲张出血患者中。
