Follow-up and risk factors analysis of liver function after transjugular intrahepatic portosystemic shunt

doi:10.3877/cma.j.issn.2095-5782.2022.01.009

Abstract

Abstract:

Objective

To investigate the changes of liver function after transjugular intrahepatic portosystemic shunt (TIPS), and to analyze the risk factors of liver injury after TIPS.

Methods

A total of198 patients with portal hypertension due to cirrhosis admitted to Nanfang Hospital of Southern Medical University from Apr. 2017 to Aug. 2019 were enrolled in this study, and received TIPS successfully. Model for end-stage liver disease (MELD) score and Child-Pugh score were followed up at 1, 3, 6, 12, 18 and 24 months after TIPS. Unconditional Logistic regression model was used to screen out the independent risk factors of postoperative severe liver injury. Receiver operating characteristic curve was plotted and the area under it was calculated to evaluate the diagnose performance.

Results

MELD score increased significantly from 1month after TIPS (13.8 ± 3.9 vs 11.0 ± 3.4; P < 0.001), then gradually decreased until 1 year after TIPS and slowly increased again, but it was always significantly higher than preoperative baseline level. Child-Pugh score gradually decreased from 6 months after TIPS, and reached the lowest value at 1 year after TIPS (6.6 ±1.3 vs 6.9 ± 1.4; P = 0.027), then slowly returned to preoperative baseline level. Liver cancer, preoperative MELD score and Child-Pugh score were independent risk factors for severe liver injury at 1 year after TIPS (OR = 4.452, P = 0.012; OR = 1.320, P = 0.001; OR = 1.509, P = 0.033), the cut-off values of preoperative MELD score and Child-Pugh score were 13.5 and 7.5, respectively.

Conclusions

Liver function after TIPS was impaired to varying degrees due to mechanical injury and intrahepatic portosystemic shunt. Liver cancer, preoperative MELD score and Child-Pugh score were independent risk factors for severe liver injury at 1 year after TIPS.

Key words: Transjugular intrahepatic portosystemic shunt, Liver function, Severe liver injury, Risk factors

Qing Tan, Jiangyun Wang, Qifeng Peng, Fang Liu, Yiping Gao, Shiqin Su, Bei Guo, Jianbo Zhao. Follow-up and risk factors analysis of liver function after transjugular intrahepatic portosystemic shunt[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(01): 50-55.

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Figures/Tables 5

References 19

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指标		数值
年龄		51.6 ± 11.0
	≤50岁	101（51.0%）
	> 50岁	097（49.0%）
性别
	男性	148（74.7%）
	女性	050（25.3%）
病因
	病毒性	140（70.7%）
	酒精性	016（8.1%）
	其他	042（21.2%）
术前症状
	消化道出血	164（82.8%）
	顽固性腹水	034（17.2%）
原发性肝癌		021（10.6%）
术前PPG		23.3 ± 5.3
术后PPG		10.3 ± 3.6
PPG差值		13.0 ± 4.8
自发性分流		027（13.6%）
门静脉血栓		044（22.2%）
门静脉穿刺部位
	左支	083（41.9%）
	右支	115（58.1%）
曲张静脉栓塞		158（79.8%）
血小板		89.4 ± 70.6
MELD评分		11.0 ± 3.4
Child-Pugh评分		7.1 ± 1.5
	A级	074（37.4%）
	B级	113（57.1%）
	C级	011（5.5%）

指标		数值
年龄		51.6 ± 11.0
	≤50岁	101（51.0%）
	> 50岁	097（49.0%）
性别
	男性	148（74.7%）
	女性	050（25.3%）
病因
	病毒性	140（70.7%）
	酒精性	016（8.1%）
	其他	042（21.2%）
术前症状
	消化道出血	164（82.8%）
	顽固性腹水	034（17.2%）
原发性肝癌		021（10.6%）
术前PPG		23.3 ± 5.3
术后PPG		10.3 ± 3.6
PPG差值		13.0 ± 4.8
自发性分流		027（13.6%）
门静脉血栓		044（22.2%）
门静脉穿刺部位
	左支	083（41.9%）
	右支	115（58.1%）
曲张静脉栓塞		158（79.8%）
血小板		89.4 ± 70.6
MELD评分		11.0 ± 3.4
Child-Pugh评分		7.1 ± 1.5
	A级	074（37.4%）
	B级	113（57.1%）
	C级	011（5.5%）

	MELD评分		Child-Pugh评分
	均值±标准差	P值	均值±标准差	P值
术前	11.0 ± 3.4	< 0.001^a	7.1 ± 1.5	0.717
术后1个月	13.8 ± 3.9	（n = 198）	7.1 ± 1.4	（n = 198）
术前	10.9 ± 3.3	< 0.001^a	7.1 ± 1.5	1.000
术后3个月	13.5 ± 3.8	（n = 180）	7.1 ± 1.5	（n = 180）
术前	10.9 ± 3.2	< 0.001^a	7.0 ± 1.5	0.211
术后6个月	13.1 ± 3.5	（n = 159）	6.9 ± 1.4	（n = 159）
术前	10.9 ± 3.1	< 0.001^a	6.9 ± 1.4	0.027^a
术后12个月	12.6 ± 3.5	（n = 135）	6.6 ± 1.3	（n = 135）
术前	10.7 ± 2.9	< 0.001^a	6.9 ± 1.4	0.818
术后18个月	12.7 ± 3.1	（n = 74）	6.8 ± 1.4	（n = 74）
术前	10.8 ± 3.1	< 0.001^a	6.7 ± 1.4	1.000
术后24个月	12.9 ± 4.0	（n = 50）	6.7 ± 1.5	（n = 50）

	MELD评分		Child-Pugh评分
	均值±标准差	P值	均值±标准差	P值
术前	11.0 ± 3.4	< 0.001^a	7.1 ± 1.5	0.717
术后1个月	13.8 ± 3.9	（n = 198）	7.1 ± 1.4	（n = 198）
术前	10.9 ± 3.3	< 0.001^a	7.1 ± 1.5	1.000
术后3个月	13.5 ± 3.8	（n = 180）	7.1 ± 1.5	（n = 180）
术前	10.9 ± 3.2	< 0.001^a	7.0 ± 1.5	0.211
术后6个月	13.1 ± 3.5	（n = 159）	6.9 ± 1.4	（n = 159）
术前	10.9 ± 3.1	< 0.001^a	6.9 ± 1.4	0.027^a
术后12个月	12.6 ± 3.5	（n = 135）	6.6 ± 1.3	（n = 135）
术前	10.7 ± 2.9	< 0.001^a	6.9 ± 1.4	0.818
术后18个月	12.7 ± 3.1	（n = 74）	6.8 ± 1.4	（n = 74）
术前	10.8 ± 3.1	< 0.001^a	6.7 ± 1.4	1.000
术后24个月	12.9 ± 4.0	（n = 50）	6.7 ± 1.5	（n = 50）

		单因素分析		多因素分析
		P值	OR（95%CI）	P值	OR（95%CI）
年龄
	≤50岁	NA
	> 50岁	0.476	1.270（0.657~2.454）
性别
	男性	NA
	女性	0.372	1.420（0.658~3.063）
病因
	病毒性	NA
	酒精性	0.512	0.634（0.163~2.471）
	其他	0.569	0.778（0.328~1.844）
术前症状
	消化道出血	NA	NA
	顽固性腹水	0.001^a	4.157（1.819~9.499）	0.547	1.365（0.497~3.748）
原发性肝癌
	否	NA	NA
	是	0.020^a	3.389（1.210~9.487）	0.012a	4.452（1.382~14.340）
术前PPG		0.596	1.017（0.956~1.081）
术后PPG		0.181	1.061（0.973~1.158）
PPG差值		0.645	0.984（0.921~1.052）
自发性分流
	否	NA
	是	0.127	0.413（0.132~1.287）
门静脉血栓
	否	NA
	是	0.301	1.504（0.694~3.263）
门静脉穿刺部位
	左支	NA
	右支	0.480	0.786（0.404~1.533）
曲张静脉栓塞
	否	NA
	是	0.929	0.965（0.439~2.119）
血小板		0.268	0.997（0.992~1.002）
MELD评分		< 0.001^a	1.482（1.282~1.714）	0.001^a	1.320（1.116~1.561）
Child-Pugh评分		< 0.001^a	2.186（1.626~2.940）	0.033^a	1.509（1.035~2.200）

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