Adlakha Natasha, Russo Mark W
Division of Gastroenterology, Atrium Health-Carolinas Medical Center, Charlotte, NC 28203, USA.
Division of Hepatology, Atrium Health-Carolinas Medical Center, Charlotte, NC 28203, USA.
J Clin Med. 2020 Jan 31;9(2):381. doi: 10.3390/jcm9020381.
Transjugular intrahepatic portosystemic shunt (TIPS) is effective at treating ascites and variceal bleeding but may be associated with increased morbidity and mortality in older patients. Our aim was to report outcomes in patients 70 years and older who underwent TIPS because data are limited in this population. We performed a retrospective review of patients who underwent TIPS at our institution over 10 years. We matched those 70 years and older to those 50-59 years old by year of TIPS and the Model for End-Stage Liver Diseae-Sodium (MELD-Na). Thirty-day readmissions were higher in the elderly group ( = 50) compared to the younger group ( = 50), = 17 (34%) and = 6 (12%) ( = 0.02), respectively. Readmissions for post-TIPS hepatic encephalopathy (HE) in the older and younger groups were = 14 (28%) and = 5 (10%) ( = 0.04), respectively. Thirty-day mortality was higher in the older group compared to the younger group, but the difference was not statistically significant, 24% and 12%, respectively ( = 0.19). TIPS can be performed safely in patients 70 years and older, but the overall readmissions, and specifically for HE, were significantly higher in older patients. Patients 70 years and older should be followed closely after TIPS, and early introduction of treatment for encephalopathy should be considered.
经颈静脉肝内门体分流术（TIPS）在治疗腹水和静脉曲张出血方面有效，但可能会增加老年患者的发病率和死亡率。我们的目的是报告70岁及以上接受TIPS治疗患者的预后情况，因为该人群的数据有限。我们对在我们机构10年间接受TIPS治疗的患者进行了回顾性研究。我们根据TIPS年份和终末期肝病-钠模型（MELD-Na）将70岁及以上的患者与50-59岁的患者进行匹配。老年组（n = 50）的30天再入院率高于年轻组（n = 50），分别为17例（34%）和6例（12%）（P = 0.02）。老年组和年轻组TIPS后肝性脑病（HE）的再入院率分别为14例（28%）和5例（10%）（P = 0.04）。老年组的30天死亡率高于年轻组，但差异无统计学意义，分别为24%和12%（P = 0.19）。70岁及以上的患者可以安全地进行TIPS，但老年患者的总体再入院率，尤其是HE的再入院率明显更高。70岁及以上的患者在TIPS后应密切随访，并应考虑尽早引入脑病治疗。
