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Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients

Dajti, E; Renzulli, M; Colecchia, A; Bacchi-Reggiani, ML; Milandri, M; Rossini, B; Ravaioli, F; ... Festi, D; + view all (2021) Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients. Digestive and Liver Disease 10.1016/j.dld.2020.12.114. (In press).

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Abstract

Background: The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated. Aims: To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation. Methods: This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome. Results: SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129–6.664]. During a follow-up of 37 (20–63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259–4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016–7.070) and multiple (SHR:3.832; 95%-IC: 2.004–7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521–4.569). Conclusions: The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.

Type: Article
Title: Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients
Location: Netherlands
DOI: 10.1016/j.dld.2020.12.114
Publisher version: https://doi.org/10.1016/j.dld.2020.12.114
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Collaterals, Hepatic encephalopathy, Liver imaging, Portal hypertension
UCL classification: UCL
UCL > Provost and Vice Provost Offices
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/10119821
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