Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
PLoS One. 2020 Jun 25;15(6):e0235199. doi: 10.1371/journal.pone.0235199. eCollection 2020.
BACKGROUND & AIMS: The management of patients with refractory ascites (RA) is challenging, particularly at higher age. Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for RA, but safety data in elderly patients are rare. Our aim was to evaluate the safety and feasibility of TIPS in elderly patients with RA.
Overall, 160 consecutive cirrhotic patients receiving a TIPS for RA at Hannover Medical School between 2012 and 2018 were considered for this retrospective analysis. Periinterventional complications such as acute-on-chronic liver failure (ACLF) as well as survival were compared between patients <65 and ≥65 years. Propensity score matching was conducted to match elderly TIPS patients and patients treated with paracentesis.
A number of 53 out of the 160 patients were ≥65 years (33%). Periinterventional course in those ≥65 years appeared to be slightly more complicated than in <65 years as reflected by a significantly longer hospital stay (p = 0.030) and more ACLF-episodes (21% vs. 9%; p = 0.044). 28-day mortality was similar between both groups (p = 0.350), whereas survival of the younger patients was significantly higher at 90 days (p = 0.029) and numerically higher at 1 year (p = 0.171). In the multivariate analysis age ≥65 years remained an independent predictor for 90-day mortality (HR: 2.58; p = 0.028), while it was not associated with 28-day and 1-year survival. Importantly, after matching for potential confounders 1-year survival was similar in elderly patients if treated with TIPS or paracentesis (p = 0.419).
TIPS placement in elderly patients with RA appears to be slightly more complicated compared to younger individuals, but overall feasible and at least not inferior to paracentesis.
难治性腹水（RA）的管理颇具挑战性，尤其是在高龄患者中。经颈静脉肝内门体分流术（TIPS）是治疗 RA 的一种成熟方法，但高龄患者的安全性数据较为罕见。本研究旨在评估 TIPS 治疗 RA 高龄患者的安全性和可行性。
回顾性分析 2012 年至 2018 年期间在汉诺威医学院接受 TIPS 治疗 RA 的 160 例连续肝硬化患者，所有患者均纳入本研究。比较<65 岁和≥65 岁患者围手术期并发症（如慢加急性肝衰竭[ACLF]）和生存率。采用倾向评分匹配法对 TIPS 治疗的老年患者和行腹腔穿刺术治疗的患者进行匹配。
160 例患者中有 53 例（33%）年龄≥65 岁。≥65 岁患者的围手术期过程似乎比<65 岁患者稍复杂，表现为住院时间明显延长（p=0.030）和 ACLF 发作更多（21% vs. 9%；p=0.044）。两组 28 天死亡率无差异（p=0.350），但年轻患者 90 天生存率明显更高（p=0.029），1 年生存率也略高（p=0.171）。多变量分析显示，年龄≥65 岁是 90 天死亡率的独立预测因素（HR：2.58；p=0.028），但与 28 天和 1 年生存率无关。重要的是，在对潜在混杂因素进行匹配后，TIPS 治疗或腹腔穿刺术治疗的老年患者 1 年生存率相似（p=0.419）。
与年轻患者相比，TIPS 治疗 RA 高龄患者的操作过程略复杂，但总体可行，且至少不劣于腹腔穿刺术。
