Saad Nael, Rude Mary Katherine, Darcy Michael, Hanin Jacob B, Wentworth Ashley, Korenblat Kevin M
Vascular and Interventional Radiology and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO USA.
Hepatology Section, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO USA.
Ann Hepatol. 2016 Mar-Apr;15(2):215-221. doi: 10.5604/16652681.1193716.
INTRODUCTION & AIM: The role of age as a predictor of mortality after transjugular intra hepatic portosystemic shunt (TIPS) is controversial. Age has been found to be an important predictor of post-TIPS mortality in some, but not all, studies and is not a component of the MELD score. The purpose of this study was to compare the 90-day survival of subjects with cirrhosis age ≥ 70 years with younger subjects undergoing TIPS.
A database of adult with cirrhosis undergoing TIPS from 2003-2011 was analyzed. The primary endpoint was survival 90-days post-TIPS. Survival was analyzed by the Kaplan-Meier method and proportional hazard modeling.
539 subjects met study criteria. 474 (88%) were between the ages of 24-69 and 65 (12%) were age 70-89 years. The groups were similar with respect to the indication for TIPS, mean MELD score and distribution of MELD score. Survival 90-days post-TIPS was 60% in the older cohort compared with 85% in the younger cohort (p < 0.001). Proportional hazards modeling controlled for comorbidities identified age ≥ 70 and MELD score as predictors of early post-TIPS survival. The hazard ratio associated with age increased monotonically, became significant at age ≥ 70 years (HR 3.22; 95% CI 1.81-5.74; p < 0.001) and exceeded the effect of MELD on survival.
Age ≥ 70 was associated with reduced survival within 90 days following TIPS. The findings from this study indicate that age is a relevant consideration in assessing the early mortality risk of TIPS.
年龄作为经颈静脉肝内门体分流术（TIPS）后死亡率的预测指标，其作用存在争议。在部分但并非所有研究中，年龄被发现是TIPS术后死亡率的重要预测指标，且不是终末期肝病模型（MELD）评分的组成部分。本研究的目的是比较年龄≥70岁的肝硬化患者与接受TIPS的年轻患者的90天生存率。
分析了2003年至2011年接受TIPS的成年肝硬化患者数据库。主要终点是TIPS术后90天的生存率。采用Kaplan-Meier法和比例风险模型分析生存率。
539名受试者符合研究标准。474名（88%）年龄在24至69岁之间，65名（12%）年龄在70至89岁之间。两组在TIPS的适应证、平均MELD评分和MELD评分分布方面相似。老年队列TIPS术后90天生存率为60%，而年轻队列则为85%（p<0.001）。对合并症进行控制的比例风险模型确定年龄≥70岁和MELD评分是TIPS术后早期生存的预测指标。与年龄相关的风险比单调增加，在年龄≥70岁时变得显著（风险比3.22；95%置信区间1.81-5.74；p<0.001），且超过了MELD对生存的影响。
年龄≥70岁与TIPS术后90天内生存率降低相关。本研究结果表明，在评估TIPS的早期死亡风险时，年龄是一个需要考虑的相关因素。
