Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany.
Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria.
Hepatol Commun. 2022 Mar;6(3):621-632. doi: 10.1002/hep4.1829. Epub 2021 Sep 28.
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension-related complications. However, careful selection of patients is crucial. The aim of this study was to evaluate the prognostic value of serum cholinesterase (CHE) for outcomes and mortality after TIPS insertion. In this multicenter study, 389 consecutive patients with cirrhosis receiving a TIPS at Hannover Medical School, University Hospital Essen, or Medical University of Vienna were included. The Hannover cohort (n = 200) was used to initially explore the role of CHE, whereas patients from Essen and Vienna served as a validation cohort (n = 189). Median age of the patients was 58 years and median Model for End-Stage Liver Disease (MELD) score was 12. Multivariable analysis identified MELD score (hazard ratio [HR]: 1.16; P < 0.001) and CHE (HR: 0.61; P = 0.008) as independent predictors for 1-year survival. Using the Youden Index, a CHE of 2.5 kU/L was identified as optimal threshold to predict post-TIPS survival in the Hannover cohort (P < 0.001), which was confirmed in the validation cohort (P = 0.010). CHE < 2.5 kU/L was significantly associated with development of acute-on-chronic liver failure (P < 0.001) and hepatic encephalopathy (P = 0.006). Of note, CHE was also significantly linked to mortality in the subgroup of patients with refractory ascites (P = 0.001) as well as in patients with high MELD scores (P = 0.012) and with high-risk FIPS scores (P = 0.004). After propensity score matching, mortality was similar in patients with ascites and CHE < 2.5 kU/L if treated by TIPS or by paracentesis. Contrarily, in patients with CHE ≥ 2.5 kU/L survival was significantly improved by TIPS as compared to treatment with paracentesis (P < 0.001). Conclusion: CHE is significantly associated with mortality and complications after TIPS insertion. Therefore, we suggest that CHE should be evaluated as an additional parameter for selecting patients for TIPS implantation.
经颈静脉肝内门体分流术（TIPS）是治疗门静脉高压相关并发症的有效方法。然而，患者的选择至关重要。本研究旨在评估血清胆碱酯酶（CHE）对 TIPS 置入术后结局和死亡率的预测价值。在这项多中心研究中，共纳入了在汉诺威医学院、埃森大学医院和维也纳医科大学接受 TIPS 治疗的 389 例肝硬化连续患者。汉诺威队列（n=200）用于初步探讨 CHE 的作用，而埃森和维也纳的患者作为验证队列（n=189）。患者的中位年龄为 58 岁，中位终末期肝病模型（MELD）评分为 12。多变量分析确定 MELD 评分（风险比 [HR]：1.16；P<0.001）和 CHE（HR：0.61；P=0.008）是 1 年生存率的独立预测因素。使用 Youden 指数，在汉诺威队列中确定 CHE 为 2.5 kU/L 为预测 TIPS 后生存的最佳阈值（P<0.001），在验证队列中得到了验证（P=0.010）。CHE<2.5 kU/L 与慢性肝衰竭急性发作（P<0.001）和肝性脑病（P=0.006）的发生显著相关。值得注意的是，CHE 与难治性腹水（P=0.001）、MELD 评分高（P=0.012）和高危 FIPS 评分（P=0.004）患者的死亡率也显著相关。在倾向评分匹配后，如果接受 TIPS 或经皮穿刺引流治疗，腹水和 CHE<2.5 kU/L 的患者死亡率相似。相反，CHE≥2.5 kU/L 的患者的生存率明显优于经皮穿刺引流治疗（P<0.001）。结论：CHE 与 TIPS 置入术后的死亡率和并发症显著相关。因此，我们建议将 CHE 评估作为 TIPS 植入患者选择的附加参数。
