Loosen Sven H, Weigel Christian, Kunstein Anselm, Minko Peter, Antoch Gerald, Bode Johannes G, Luedde Tom, Roderburg Christoph, Kostev Karel
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düesseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf (CIOABCD), Kerpener Straße 62, 50937 Köln, Germany.
Diagnostics (Basel). 2025 Jul 29;15(15):1902. doi: 10.3390/diagnostics15151902.
The transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for complications of portal hypertension in patients with liver cirrhosis. While its use has increased and indications have broadened in recent years, recent comprehensive data on patient characteristics, trends, and in-hospital mortality in Germany are lacking. This study aimed to evaluate current clinical patterns and mortality outcomes associated with TIPS. This nationwide cross-sectional study used anonymized hospital data from the German InEK database between 2019 and 2023. TIPS procedures were identified using relevant OPS codes. Patient demographics, liver cirrhosis stage (Child-Pugh), hepatic encephalopathy grade, comorbid conditions, and in-hospital mortality were analyzed descriptively. Analyses were conducted using SAS 9.4. A total of 12,905 TIPS procedures were documented. Annual case numbers rose from 2180 in 2019 to 2954 in 2023. Most patients were male (66.3%) and aged 60-74 years. Ascites (68.6%) was the most frequent associated diagnosis, followed by variceal bleeding (16.4%) and hepatorenal syndrome (14.9%). The average hospital stay decreased from 19.6 to 16.8 days. Overall in-hospital mortality was 8.5%, increasing with age (13.0% in ≥75 years), Child-Pugh C cirrhosis (14.9%), PCCL grade 4 (17.6%), hepatorenal syndrome (16.7%), and grade 4 hepatic encephalopathy (56.1%). TIPS usage in Germany has increased over the past five years, with a shift toward earlier disease stages. Higher in-hospital mortality in clinically complex patients underscores the importance of careful patient selection and tailored management strategies in high-risk groups.
经颈静脉肝内门体分流术（TIPS）是治疗肝硬化患者门静脉高压并发症的一种成熟疗法。尽管近年来其应用有所增加且适应证有所拓宽，但德国目前缺乏关于患者特征、趋势及住院死亡率的综合数据。本研究旨在评估与TIPS相关的当前临床模式及死亡结局。这项全国性横断面研究使用了2019年至2023年德国InEK数据库中的匿名医院数据。通过相关的OPS编码识别TIPS手术。对患者人口统计学特征、肝硬化分期（Child-Pugh）、肝性脑病分级、合并症及住院死亡率进行描述性分析。使用SAS 9.4进行分析。共记录了12,905例TIPS手术。年病例数从2019年的2180例增至2023年的2954例。大多数患者为男性（66.3%），年龄在60 - 74岁之间。腹水（68.6%）是最常见的相关诊断，其次是静脉曲张出血（16.4%）和肝肾综合征（14.9%）。平均住院天数从19.6天降至16.8天。总体住院死亡率为8.5%，随年龄增长而升高（≥75岁患者中为13.0%），Child-Pugh C级肝硬化患者为14.9%，PCCL 4级患者为17.6%，肝肾综合征患者为16.7%，4级肝性脑病患者为56.1%。在过去五年中，德国TIPS的使用有所增加，且有向疾病早期阶段转变的趋势。临床复杂患者较高的住院死亡率凸显了在高危人群中谨慎选择患者及制定个性化管理策略的重要性。
