Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk

Ahmad Parvinian, Kruti D. Shah, Patrick M. Couture, Jeet Minocha, Grace Knuttinen, James T. Bui, Ron C. Gaba

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: To identify prognostic factors for early mortality among patients with intermediate-risk Model for End-stage Liver Disease (MELD) scores undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods: In this single-institution retrospective study, 47 patients (31 men; mean age, 54 y) with intermediate MELD scores (ie, 18-25) underwent TIPS creation between 1999 and 2012. Medical records were reviewed to identify demographic (age, sex), liver disease (Child-Pugh, MELD), and procedure data (indication, urgency, stent type, portosystemic pressure gradient reduction, complications), and the influence of these parameters on 90-day mortality was assessed by multivariate binary logistic regression analysis. Results: TIPSs were successfully created for variceal hemorrhage (n = 24), ascites (n = 17), hydrothorax (n = 5), and portal vein thrombosis (n = 1). Hemodynamic success rate was 94% (44 of 47), and mean portosystemic pressure gradient reduction was 13 mm Hg. The 90-day mortality rate was 36% (17 of 47). Patient age (P =.026) was significantly associated with 90-day mortality. Mean ages of living versus dead patients were 51 and 60 years, and mortality rates in patients aged 54 years or younger versus 55 years or older were 21% (five of 24) and 52% (12 of 23), respectively. There was no difference in MELD scores between these age groups (20.6 vs 21.0; P =.600), and MELD score was not a predictive factor on regression analysis. Conclusions: Age is a prognostic factor for early mortality in TIPS recipients with intermediate MELD scores. Mortality rates are higher in patients at least 55 years of age, but MELD score does not predict survival in this subset. Age should be contemplated when selecting patients at intermediate risk for TIPS creation.

Original languageEnglish (US)
Pages (from-to)941-946
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
End Stage Liver Disease
Mortality
Regression Analysis
Hydrothorax
Pressure
Portal Vein
Ascites
Stents
Medical Records
Liver Diseases
Thrombosis
Retrospective Studies
Age Groups
Logistic Models
Hemodynamics
Demography
Hemorrhage
Survival

Keywords

  • MELD
  • Model for End-stage Liver Disease
  • TIPS
  • transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk. / Parvinian, Ahmad; Shah, Kruti D.; Couture, Patrick M.; Minocha, Jeet; Knuttinen, Grace; Bui, James T.; Gaba, Ron C.

In: Journal of Vascular and Interventional Radiology, Vol. 24, No. 7, 01.07.2013, p. 941-946.

Research output: Contribution to journalArticle

Parvinian, Ahmad ; Shah, Kruti D. ; Couture, Patrick M. ; Minocha, Jeet ; Knuttinen, Grace ; Bui, James T. ; Gaba, Ron C. / Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk. In: Journal of Vascular and Interventional Radiology. 2013 ; Vol. 24, No. 7. pp. 941-946.
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abstract = "Purpose: To identify prognostic factors for early mortality among patients with intermediate-risk Model for End-stage Liver Disease (MELD) scores undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods: In this single-institution retrospective study, 47 patients (31 men; mean age, 54 y) with intermediate MELD scores (ie, 18-25) underwent TIPS creation between 1999 and 2012. Medical records were reviewed to identify demographic (age, sex), liver disease (Child-Pugh, MELD), and procedure data (indication, urgency, stent type, portosystemic pressure gradient reduction, complications), and the influence of these parameters on 90-day mortality was assessed by multivariate binary logistic regression analysis. Results: TIPSs were successfully created for variceal hemorrhage (n = 24), ascites (n = 17), hydrothorax (n = 5), and portal vein thrombosis (n = 1). Hemodynamic success rate was 94{\%} (44 of 47), and mean portosystemic pressure gradient reduction was 13 mm Hg. The 90-day mortality rate was 36{\%} (17 of 47). Patient age (P =.026) was significantly associated with 90-day mortality. Mean ages of living versus dead patients were 51 and 60 years, and mortality rates in patients aged 54 years or younger versus 55 years or older were 21{\%} (five of 24) and 52{\%} (12 of 23), respectively. There was no difference in MELD scores between these age groups (20.6 vs 21.0; P =.600), and MELD score was not a predictive factor on regression analysis. Conclusions: Age is a prognostic factor for early mortality in TIPS recipients with intermediate MELD scores. Mortality rates are higher in patients at least 55 years of age, but MELD score does not predict survival in this subset. Age should be contemplated when selecting patients at intermediate risk for TIPS creation.",
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T1 - Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk

AU - Parvinian, Ahmad

AU - Shah, Kruti D.

AU - Couture, Patrick M.

AU - Minocha, Jeet

AU - Knuttinen, Grace

AU - Bui, James T.

AU - Gaba, Ron C.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Purpose: To identify prognostic factors for early mortality among patients with intermediate-risk Model for End-stage Liver Disease (MELD) scores undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods: In this single-institution retrospective study, 47 patients (31 men; mean age, 54 y) with intermediate MELD scores (ie, 18-25) underwent TIPS creation between 1999 and 2012. Medical records were reviewed to identify demographic (age, sex), liver disease (Child-Pugh, MELD), and procedure data (indication, urgency, stent type, portosystemic pressure gradient reduction, complications), and the influence of these parameters on 90-day mortality was assessed by multivariate binary logistic regression analysis. Results: TIPSs were successfully created for variceal hemorrhage (n = 24), ascites (n = 17), hydrothorax (n = 5), and portal vein thrombosis (n = 1). Hemodynamic success rate was 94% (44 of 47), and mean portosystemic pressure gradient reduction was 13 mm Hg. The 90-day mortality rate was 36% (17 of 47). Patient age (P =.026) was significantly associated with 90-day mortality. Mean ages of living versus dead patients were 51 and 60 years, and mortality rates in patients aged 54 years or younger versus 55 years or older were 21% (five of 24) and 52% (12 of 23), respectively. There was no difference in MELD scores between these age groups (20.6 vs 21.0; P =.600), and MELD score was not a predictive factor on regression analysis. Conclusions: Age is a prognostic factor for early mortality in TIPS recipients with intermediate MELD scores. Mortality rates are higher in patients at least 55 years of age, but MELD score does not predict survival in this subset. Age should be contemplated when selecting patients at intermediate risk for TIPS creation.

AB - Purpose: To identify prognostic factors for early mortality among patients with intermediate-risk Model for End-stage Liver Disease (MELD) scores undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods: In this single-institution retrospective study, 47 patients (31 men; mean age, 54 y) with intermediate MELD scores (ie, 18-25) underwent TIPS creation between 1999 and 2012. Medical records were reviewed to identify demographic (age, sex), liver disease (Child-Pugh, MELD), and procedure data (indication, urgency, stent type, portosystemic pressure gradient reduction, complications), and the influence of these parameters on 90-day mortality was assessed by multivariate binary logistic regression analysis. Results: TIPSs were successfully created for variceal hemorrhage (n = 24), ascites (n = 17), hydrothorax (n = 5), and portal vein thrombosis (n = 1). Hemodynamic success rate was 94% (44 of 47), and mean portosystemic pressure gradient reduction was 13 mm Hg. The 90-day mortality rate was 36% (17 of 47). Patient age (P =.026) was significantly associated with 90-day mortality. Mean ages of living versus dead patients were 51 and 60 years, and mortality rates in patients aged 54 years or younger versus 55 years or older were 21% (five of 24) and 52% (12 of 23), respectively. There was no difference in MELD scores between these age groups (20.6 vs 21.0; P =.600), and MELD score was not a predictive factor on regression analysis. Conclusions: Age is a prognostic factor for early mortality in TIPS recipients with intermediate MELD scores. Mortality rates are higher in patients at least 55 years of age, but MELD score does not predict survival in this subset. Age should be contemplated when selecting patients at intermediate risk for TIPS creation.

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