Li Renxi, Lee SeungEun, Caldwell Peter C, Tsavaris Katherine L, Sarin Shawn N
The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
Department of Medicine, The George Washington University Hospital, Washington, DC, USA.
Dig Dis Sci. 2025 Jun 11. doi: 10.1007/s10620-025-09130-8.
Hepatorenal syndrome (HRS) is a severe complication of cirrhosis associated with poor survival. The use of transjugular intrahepatic portosystemic shunt (TIPS) as a therapeutic or bridging therapy for HRS patients remains debated due to its potential severe early complications. This study aimed to retrospectively compare the in-hospital outcomes of HRS patients who received TIPS with those who did not, using a large-scale, population-based national database.
This study identified patients with HRS in National/Nationwide Inpatient Sample (NIS) database from Q4 2015-2021. A 1:3 propensity-score matching was used to match demographics, socioeconomic status, primary payer status, hospital characteristics, clinical presentations, APR-DRG mortality class, etiology of cirrhosis, and comorbidities between TIPS and non-TIPS cohorts. In-hospital outcomes were compared.
The NIS database identified 55,545 HRS patients, where 479 patients underwent TIPS. African American patients and those in rural or smaller hospitals were significantly less likely to receive TIPS. Following propensity-score matching, 1,441 HRS patients who did not undergo TIPS were matched to all patients who underwent the procedure. In-hospital mortality (22.59% vs 24.36%, p = 0.46), hepatic encephalopathy (37.87% vs 35.95%, p = 0.48), and liver transplantation rates (7.11% vs 8.26%, p = 0.50) were comparable between patients who underwent TIPS and those who did not. However, patients who underwent TIPS had a longer length of stay (p < 0.01) and higher total hospital charges (p < 0.01) but had a lower transfer-out rate (p < 0.01).
TIPS does not appear to negatively impact immediate outcomes and could be considered as a potentially therapeutic treatment option for suitable candidates, considering its long-term benefits. Future studies should focus on the long-term prognosis of patients who received TIPS and the potential role of TIPS as a bridging therapy to liver transplantation. Moreover, there could be potential racial and institutional disparities in accessing/offering TIPS that may warrant further investigation.
肝肾综合征（HRS）是肝硬化的一种严重并发症，与生存率低相关。经颈静脉肝内门体分流术（TIPS）作为HRS患者的治疗或桥接治疗方法，因其潜在的严重早期并发症而仍存在争议。本研究旨在使用大规模的基于人群的国家数据库，回顾性比较接受TIPS的HRS患者与未接受TIPS的患者的院内结局。
本研究在2015年第四季度至2021年的国家/全国住院患者样本（NIS）数据库中识别HRS患者。采用1:3倾向评分匹配法，对TIPS组和非TIPS组之间的人口统计学、社会经济状况、主要支付者状况、医院特征、临床表现、APR-DRG死亡率类别、肝硬化病因和合并症进行匹配。比较院内结局。
NIS数据库识别出55545例HRS患者，其中479例接受了TIPS。非裔美国患者以及农村或小型医院的患者接受TIPS的可能性明显较低。倾向评分匹配后，1441例未接受TIPS的HRS患者与所有接受该手术的患者进行了匹配。接受TIPS的患者与未接受TIPS的患者相比，院内死亡率（22.59%对24.36%，p = 0.46）、肝性脑病（37.87%对35.95%，p = 0.48）和肝移植率（7.11%对8.26%，p = 0.50）相当。然而，接受TIPS的患者住院时间更长（p < 0.01），总住院费用更高（p < 0.01），但转出率更低（p < 0.01）。
考虑到TIPS的长期益处，TIPS似乎不会对近期结局产生负面影响，对于合适的患者可将其视为一种潜在的治疗选择。未来的研究应关注接受TIPS患者的长期预后以及TIPS作为肝移植桥接治疗的潜在作用。此外，在获得/提供TIPS方面可能存在潜在的种族和机构差异，这可能值得进一步研究。
