Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding.
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Rudler Marika, Hernández-Gea Virginia, Procopet Bogdan Dumitru, Giráldez Alvaro, Amitrano Lucio, Villanueva Càndid, Ibañez Luis, Silva-Junior Gilberto, Genesca Joan, Bureau Christophe, Trebicka Jonel, Bañares Rafael, Krag Aleksander, Llop Elba, Laleman Wim, Palazon Jose Maria, Castellote Jose, Rodrigues Susana, Gluud Lise Lotte, Noronha Ferreira Carlos, Canete Nouria, Rodríguez Manuel, Ferlitsch Arnulf, Mundi Jose Luis, Gronbaek Henning, Hernandez-Guerra Manuel, Sassatelli Romano, Dell'era Alessandra, Senzolo Marco, Abraldes Juan G, Romero-Gómez Manuel, Zipprich Alexander, Casas Meritxell, Masnou Helena, Larrue Hélène, Primignani Massimo, Nevens Frederik, Calleja Jose Luis, Schwarzer Remy, Jansen Christian, Robic Marie-Angèle, Conejo Irene, Martínez Gonzalez Javier, Catalina Maria Vega, Albillos Agustín, Alvarado Edilmar, Guardascione Maria Anna, Mallet Maxime, Tripon Simona, Casanovas Georgina, Bosch Jaume, Garcia-Pagan Juan-Carlos, Thabut Dominique, for International Variceal Bleeding Observational Study Group: a Baveno Cooperation
Аннотация
PATIENTS AND METHODS: This is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation.
RESULTS: 671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p<0.001). In high-risk patients with HE at admission, pTIPS was associated with a lower 1-year mortality than endoscopic+drug (HR 0.374, 95% CI 0.166 to 0.845, p=0.0181). The incidence of HE was not different between patients treated with pTIPS and endoscopic+drug (38.2% vs 38.7%, p=0.9721), even in patients with HE at admission (56.4% vs 58.7%, p=0.4594). Age >56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients.
CONCLUSION: pTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.