[Clinical analysis of blood ammonia levels for predicting survival following transjugular intrahepatic portosystemic shunt in patients with cirrhosis].

Objective

To assess the blood ammonia levels value for predicting survival following transjugular intrahepatic portosystemic shunt (TIPS) therapy in patients with cirrhosis.

Methods

Data from 236 cirrhotic patients who underwent TIPS treatment at Nanjing Drum Tower Hospital from March 2018 to January 2020 were retrospectively collected. Data included patients' blood routine, liver and kidney function, coagulation function tests, hepatic encephalopathy status, and etiology leading to TIPS treatment at the initial admission. The Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score were concurrently calculated for patients' liver function. Patients were grouped into a high AMM-ULN group and a low AMM-ULN group based on the criterion of 1.4 times the upper limit of normal for calibrated ammonia levels (AMM-ULN). Postoperative follow-up information such as rebleeding of the upper gastrointestinal tract, ascites, hepatic encephalopathy, and survival-related outcomes was collected for analysis. Measurement data that did not conform to a non-normal distribution were compared using the Mann-Whitney U test. Categorical data were compared using the χ2 test between the groups. Kaplan-Meier survival curves were used to plot survival rate. Cox regression models were used for univariate and multivariate analysis.

Results

AMM-ULN, CTP score, and ascites were independent risk factors affecting the liver function in surviving patients with cirrhosis following TIPS (P<0.05). The 3-year survival rates for the high and low AMM-ULN groups were 66.3% and 92.4%, respectively, showing a significant statistical difference (P<0.001) in terms of survival rate. AMM-ULN was superior in terms of predicting 3-year survival rates (0.850 vs. 0.598, P<0.05) compared to the CTP score and had no significant difference compared to the MELD score models in accordance with the receiver operating characteristic curves.

Conclusion

AMM-ULN is an independent predictor for cirrhotic patients who have survived following TIPS and has certain advantages in terms of predicting survival rates.