Factors predicting mortality after tips for refractory ascites: a single center experience


Autoria(s): Lodato, Francesca
Contribuinte(s)

Mazzella, Giuseppe

Data(s)

01/07/2010

Resumo

Introduction: Transjugular intrahepatic porto-systemic shunt (TIPS) is an accepted indication for treating refractory ascites. Different models have been proposed for the prediction of survival after TIPS; aim of present study was to evaluate the factors associated with mortality after TIPS for refractory ascites. Methods: Seventy-three consecutive patients undergoing a TIPS for refractory ascites in our centre between 2003 and 2008, were prospectively recorded in a database ad were the subject of the study. Mean follow-up was 17±2 months. Forty patients were awaiting liver transplantation (LT) and 12 (16.4%) underwent LT during follow-up. Results: Mean MELD at the moment of TIPS was 15.7±5.3. Overall mortality was 23.3% (n=17) with a mean survival after TIPS of 17±14 months. MELD score (B=0.161, p=0.042), AST (B= 0.020, p=0.090) and pre-TIPS HVPG (B=0.016, p=0.093) were independent predictors of overall mortality. On multivariate analysis MELD (B=0.419, p=0.018) and pre-TIPS HVPG (B=0.223, p=0.060) independently predicted 1 year survival. Patients were stratified into categories of death risk, using ROC curves for the variables MELD and HVPG. Patients with MELD<10 had a low probability of death after TIPS (n=6, 16% mortality); patients with HVPG <16 mmHg (n=6) had no mortality. Maximum risk of death was found in patients with MELD score 19 (n=16, 31% mortality) and in those with HVPG 25 mmHg (n=27, 26% mortality). Conclusions: TIPS increases overall survival in patients with refractory ascites. Liver function (assessed by MELD), necroinflammation (AST) and portal hypertension (HVPG) are independent predictors of survival; patients with MELD>19 and HVPG>25 mmHg are at highest risk of death after TIPS

Formato

application/pdf

Identificador

http://amsdottorato.unibo.it/2776/1/francesca_lodato_tesi.pdf.pdf

urn:nbn:it:unibo-2075

Lodato, Francesca (2010) Factors predicting mortality after tips for refractory ascites: a single center experience, [Dissertation thesis], Alma Mater Studiorum Università di Bologna. Dottorato di ricerca in Scienze medico-chirurgiche gastroenterologiche e dei trapianti <http://amsdottorato.unibo.it/view/dottorati/DOT381/>, 22 Ciclo. DOI 10.6092/unibo/amsdottorato/2776.

Idioma(s)

en

Publicador

Alma Mater Studiorum - Università di Bologna

Relação

http://amsdottorato.unibo.it/2776/

Direitos

info:eu-repo/semantics/openAccess

Palavras-Chave #MED/12 Gastroenterologia
Tipo

Tesi di dottorato

NonPeerReviewed