Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Vasc Interv Radiol. 2021 Nov;32(11):1606-1614. doi: 10.1016/j.jvir.2021.08.003. Epub 2021 Aug 17.
To compare patients treated with large-volume paracentesis (LVP), transjugular intrahepatic portosystemic shunt (TIPS), and peritoneovenous shunt (PVS) for ascites.
A retrospective study of 192 patients treated with LVP (94), TIPS (75), or PVS (23) was performed. Records were reviewed for patient characteristics and outcomes. The patients' age differed (LVP, 59.5 years; TIPS, 58.8 years; and PVS, 65.6 years; P = .003). Nonalcoholic steatohepatitis was the most common etiology in the PVS cohort (11/23, 47%), and hepatitis C in the TIPS (27/75, 36%), and LVP cohorts (43/94, 46%) (P = .032). The model for end-stage liver disease score was significantly different (LVP, 14; TIPS, 13; and PVS, 8; P = .035). Hepatocellular carcinoma was higher in the PVS cohort (6/23 patients, 25%) than in the TIPS (4/75, 5%), and LVP (12/94, 12%) cohorts (P = .03).
Emergency department visits and hospital readmissions were the highest in the LVP cohort (40%, ≥2 readmissions, P < .001). Patients required fewer LVPs after TIPS (1.5 to 0.14, P < .001) or PVS (2.1 to 0.5, P = .019). In an unadjusted Cox model, patients in the TIPS cohort were found to have a 58% reduction in the risk of death compared with patients in the LVP cohort (P = .003). Transplant-free survival (PVS, 44 days; TIPS, 155 days; and LVP, 213 days) differed (log rank = 0.001).
The survival in the PVS and TIPS cohorts was similar, with less healthcare utilization than the LVP cohort. PVS is a satisfactory alternative to LVP.
比较大容积腹腔穿刺术（LVP）、经颈静脉肝内门体分流术（TIPS）和经皮腹腔静脉分流术（PVS）治疗腹水的患者。
对 192 例接受 LVP（94 例）、TIPS（75 例）或 PVS（23 例）治疗的患者进行回顾性研究。评估患者的一般特征和结局。患者年龄不同（LVP：59.5 岁；TIPS：58.8 岁；PVS：65.6 岁；P=0.003）。非酒精性脂肪性肝炎是 PVS 队列中最常见的病因（11/23，47%），丙型肝炎是 TIPS（27/75，36%）和 LVP 队列（43/94，46%）的最常见病因（P=0.032）。终末期肝病模型评分有显著差异（LVP：14；TIPS：13；PVS：8；P=0.035）。PVS 队列中肝细胞癌的比例较高（23 例患者中有 6 例，25%），高于 TIPS（75 例患者中有 4 例，5%）和 LVP（94 例患者中有 12 例，12%）队列（P=0.03）。
LVP 组的急诊就诊和再入院率最高（40%，≥2 次再入院，P<0.001）。与 LVP 或 PVS 相比，TIPS 组需要的 LVP 更少（1.5 至 0.14，P<0.001）。在未校正的 Cox 模型中，与 LVP 组相比，TIPS 组患者的死亡风险降低了 58%（P=0.003）。无移植生存率（PVS：44 天；TIPS：155 天；LVP：213 天）有差异（对数秩检验：0.001）。
PVS 和 TIPS 组的生存率相似，医疗资源利用率低于 LVP 组。PVS 是 LVP 的一种满意替代方法。
