The George Washington University School of Medicine and Health Sciences, Washington, DC.
The George Washington University Hospital, Department of Interventional Radiology, Washington, DC, USA.
Eur J Gastroenterol Hepatol. 2024 Mar 1;36(3):332-337. doi: 10.1097/MEG.0000000000002703. Epub 2023 Dec 27.
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to alleviate portal hypertension in patients with decompensated liver cirrhosis. However, the risks and outcomes associated with TIPS in patients with advanced chronic kidney disease (CKD) remain uncertain. This study aimed to investigate the perioperative outcomes of TIPS procedures in patients with advanced CKD using the National Inpatient Sample (NIS) database, a comprehensive all-payer inpatient database in the US.
The study identified patients who underwent TIPS procedures in the NIS database from Q4 2015 to 2020. Patients with advanced CKD were identified using specific ICD-10-CM codes, and they were compared to patients without CKD. Preoperative variables, including demographics, indications for TIPS, comorbidities, APR-DRG subclass, primary payer status, and hospital characteristics, were noted. Perioperative outcomes were examined by multivariable logistic regression.
A total of 248 patients with advanced CKD and 5511 patients without CKD undergoing TIPS procedures were identified in the NIS database. Compared to non-CKD, patients with advanced CKD had higher mortality (13.70% vs. 8.60%, aOR = 1.56, P = 0.03), acute kidney injury (51.21% vs. 29.34, aOR = 1.46, P < 0.01), transfer out (25.00% vs. 12.84%, aOR = 1.88, P < 0.01), and length of stay over 7 days (64.11% vs. 38.97%, aOR = 2.34, P < 0.01). However, there was no difference in hepatic encephalopathy (31.85% vs. 27.19%, aOR = 1.12, P = 0.42).
Advanced CKD patients undergoing TIPS are at higher risk of mortality and AKI compared to patients without CKD; HE was mildly elevated but NS. Long-term prognosis of patients with advanced CKD who had TIPS is needed in future studies.
经颈静脉肝内门体分流术（TIPS）是一种用于缓解失代偿性肝硬化患者门静脉高压的方法。然而，在患有晚期慢性肾脏病（CKD）的患者中，TIPS 相关的风险和结果仍不确定。本研究旨在使用美国国家住院患者样本（NIS）数据库调查 TIPS 手术在晚期 CKD 患者中的围手术期结果，该数据库是一个全面的全美支付住院患者数据库。
本研究从 2015 年第四季度到 2020 年在 NIS 数据库中确定了接受 TIPS 手术的患者。使用特定的 ICD-10-CM 代码识别晚期 CKD 患者，并将其与无 CKD 患者进行比较。记录了术前变量，包括人口统计学、TIPS 适应证、合并症、APR-DRG 亚类、主要支付者状态和医院特征。通过多变量逻辑回归检查围手术期结果。
在 NIS 数据库中，共确定了 248 例晚期 CKD 患者和 5511 例无 CKD 患者接受了 TIPS 手术。与非 CKD 患者相比，晚期 CKD 患者的死亡率更高（13.70% vs. 8.60%，aOR=1.56，P=0.03）、急性肾损伤（51.21% vs. 29.34%，aOR=1.46，P<0.01）、转出（25.00% vs. 12.84%，aOR=1.88，P<0.01）和住院时间超过 7 天（64.11% vs. 38.97%，aOR=2.34，P<0.01）。然而，肝性脑病（31.85% vs. 27.19%，aOR=1.12，P=0.42）没有差异。
与无 CKD 患者相比，接受 TIPS 的晚期 CKD 患者的死亡率和急性肾损伤风险更高；但 HE 略有升高但无统计学意义。未来的研究需要对接受 TIPS 的晚期 CKD 患者的长期预后进行研究。
