Praktiknjo, M;
Simón-Talero, M;
Römer, J;
Roccarina, D;
Martínez, J;
Lampichler, K;
Baiges, A;
... Baveno VI-SPSS group of the Baveno Cooperation, .; + view all
(2020)
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis.
Journal of Hepatology
10.1016/j.jhep.2019.12.021.
(In press).
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Abstract
BACKGROUND: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcome of patients with liver cirrhosis. METHODS: In this retrospective international multicentric study, computed tomography (CT) scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. 1-year survival was primary and acute decompensation (oHE, variceal bleeding, ascites) secondary endpoint. RESULTS: 301 patients (169 male) were included in the training cohort. 30% of all patients presented >1 SPSS. TSA cut-off of 83 mm2 was determined to classify patients with small or large TSA (S-/L-TSA). L-TSA patients presented higher MELD (11 vs. 14) and more commonly history of oHE (12% vs. 21%, p<0.05). During follow up L-TSA patients developed more oHE episodes (33% vs. 47%, p<0.05) and showed lower 1-year survival than S-TSA (84% vs. 69%, p<0.001). Multivariate analysis identified L-TSA (HR 1.66, 1.02-2.70, p<0.05) as independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed L-TSA patients with lower 1-year survival (77% vs. 64%, p<0.001) and more oHE development (35% vs. 49%, p<0.001) than S-TSA. CONCLUSION: This study suggests that TSA >83mm2 increases the risk for oHE and mortality in liver cirrhosis. Our results may have impact on clinical use of TSA/SPSS for risk stratification and clinical decision-making considering management of SPSS.
| Type: | Article |
|---|---|
| Title: | Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| Location: | Netherlands |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jhep.2019.12.021 |
| Publisher version: | https://doi.org/10.1016/j.jhep.2019.12.021 |
| Language: | English |
| Additional information: | © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. Under a Creative Commons license (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
| Keywords: | ACLF, SPSS, acute decompensation, acute-on-chronic liver failure, cirrhosis, computed tomography, hepatic encephalopathy, liver, portal hypertension, portosystemic shunt, spontaneous portosystemic shunt |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10090544 |
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