In-Hospital Outcomes of Patients with Hepatorenal Syndrome Who Underwent Transjugular Intrahepatic Portosystemic Shunt Procedure.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.