Waidyaratne Gavisha, Jalil Sajid, Liu Alex, Liyanarachchi Sandya, Makary Mina S, Rikabi Ali, Acharya Chathur, Mendiratta Vivek, Peng Jing, Ma Jianing, Mumtaz Khalid
Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Dig Dis Sci. 2025 Mar 1. doi: 10.1007/s10620-025-08940-0.
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for managing major complications of cirrhosis including refractory ascites, hydrothorax, and variceal bleed. The impact of advanced age on outcomes of TIPS has not been studied comprehensively. Therefore, we aimed to study optimal advanced age cutoff in context of MELD score for patients undergoing TIPS.
A single-center retrospective analysis of all adult patients with cirrhosis, who underwent TIPS between 2002 and 2020 was performed. Univariate and multivariate analyses were conducted to determine the development of hepatic encephalopathy (HE) and mortality at 30 days and 1 year. The impact of various age groups (55, 60, 65, and 70 years) and MELD score cutoffs on mortality were elucidated.
A total of 225 patients were included. No significant associations were found between advanced age and short-term mortality (p = 0.410), short-term development of HE (p = 0.846), or secondary post-TIPS outcomes such as rebleed or need for paracentesis. However, advanced age was associated with significant differences in post TIPS mortality (p = 0.026) and inpatient development of HE (p = 0.032) at 1-year. These associations were confirmed in multivariate models. Area under the covariate adjusted receiver operating curve (AUROC) identified optimal age and MELD cutoffs as 60 years and 15 for 1-year mortality, respectively. An optimal age cutoff of 54 was identified for 1-year HE.
Advanced age is strongly associated with 1-year mortality and 1-year development of HE post-TIPS. Poorer post-TIPS outcomes were further observed in patients with higher MELD. Therefore, during selection of advanced age patients for TIPS, MELD score should be considered for better long-term outcomes.
经颈静脉肝内门体分流术（TIPS）是治疗肝硬化主要并发症（包括难治性腹水、胸腔积液和静脉曲张破裂出血）的有效干预措施。高龄对TIPS治疗效果的影响尚未得到全面研究。因此，我们旨在研究接受TIPS治疗患者在终末期肝病模型（MELD）评分背景下的最佳高龄临界值。
对2002年至2020年间接受TIPS治疗的所有成年肝硬化患者进行单中心回顾性分析。进行单因素和多因素分析以确定肝性脑病（HE）的发生情况以及30天和1年时的死亡率。阐明不同年龄组（55、60、65和70岁）和MELD评分临界值对死亡率的影响。
共纳入225例患者。未发现高龄与短期死亡率（p = 0.410）、短期HE发生（p = 0.846）或TIPS术后继发结局（如再出血或腹腔穿刺需求）之间存在显著关联。然而，高龄与1年时TIPS术后死亡率（p = 0.026）和住院期间HE发生（p = 0.032）的显著差异相关。这些关联在多因素模型中得到证实。协变量调整后的受试者工作特征曲线下面积（AUROC）确定1年死亡率的最佳年龄和MELD临界值分别为60岁和15。确定1年HE的最佳年龄临界值为54岁。
高龄与TIPS术后1年死亡率和1年HE发生密切相关。MELD较高的患者TIPS术后结局更差。因此，在选择高龄患者进行TIPS治疗时，应考虑MELD评分以获得更好的长期结局。
