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Walter A, Rudler M, Olivas P, et al. Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding. Hepatology. 2021;74(4):2085-2101doi: 10.1002/hep.31913.
Walter, A., Rudler, M., Olivas, P., Moga, L., Trépo, E., Robic, M. A., Ollivier-Hourmand, I., Baiges, A., Sutter, O., Bouzbib, C., Peron, J. M., Le Pennec, V., Ganne-Carrié, N., Garcia-Pagán, J. C., Mallet, M., Larrue, H., Dao, T., Thabut, D., Hernández-Gea, V., Nault, J. C., Bureau, C., Allaire, M. (2021). Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding. Hepatology (Baltimore, Md.), 74(4), 2085-2101. https://doi.org/10.1002/hep.31913
Walter, Aurélie, et al. "Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding." Hepatology (Baltimore, Md.) vol. 74,4 (2021): 2085-2101. doi: https://doi.org/10.1002/hep.31913
Walter A, Rudler M, Olivas P, Moga L, Trépo E, Robic MA, Ollivier-Hourmand I, Baiges A, Sutter O, Bouzbib C, Peron JM, Le Pennec V, Ganne-Carrié N, Garcia-Pagán JC, Mallet M, Larrue H, Dao T, Thabut D, Hernández-Gea V, Nault JC, Bureau C, Allaire M. Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding. Hepatology. 2021 Oct;74(4):2085-2101. doi: 10.1002/hep.31913. Epub 2021 Jul 19. PMID: 34018627.
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Hepatology. 2021 Oct;74(4):2085-2101. doi: 10.1002/hep.31913. Epub 2021 Jul 19.

Combination of Model for End-Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding.

Hepatology (Baltimore, Md.)

Aurélie Walter, Marika Rudler, Pol Olivas, Lucile Moga, Eric Trépo, Marie Angèle Robic, Isabelle Ollivier-Hourmand, Anna Baiges, Olivier Sutter, Charlotte Bouzbib, Jean Marie Peron, Vincent Le Pennec, Nathalie Ganne-Carrié, Juan Carlos Garcia-Pagán, Maxime Mallet, Hélène Larrue, Thong Dao, Dominique Thabut, Virginia Hernández-Gea, Jean-Charles Nault, Christophe Bureau, Manon Allaire,

Affiliations

  1. Service d'Hépatologie, Hôpital Avicenne, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance-publique Hôpitaux de Paris, Université Sorbonne Paris Nord, Bobigny, France.
  2. Service d'Hépato-gastro-entérologie, Hôpital de la Pitié-Salpétrière, Hôpitaux universitaires Pitié-Salpétrière-Charles Foix, Assistance-publique Hôpitaux de Paris, Paris, France.
  3. Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
  4. Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Madrid, Spain.
  5. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
  6. Service d'Hépatologie, Hôpital Beaujon, Hôpitaux universitaires Paris-Nord-Val-de-Seine, Assistance-publique Hôpitaux de Paris, Clichy, France.
  7. Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
  8. Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.
  9. Service d'hépato-gastro-entérologie, CHU Toulouse, Toulouse, France.
  10. Service d'hépato-gastroentérologie et de nutrition, CHU Côte de Nacre, Caen, France.
  11. Service de Radiologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance-publique Hôpitaux de Paris, Bondy, France.
  12. Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'universités et établissements Sorbonne Paris cité, Paris, France.
  13. Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Unité de soins intensifs d'hépatologie, Service d'hépato-gastroentérologie, Inserm, Centre de recherche Saint-Antoine, Sorbonne université, Groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance-publique Hôpitaux de Paris, Paris, France.
  14. Service de radiologie, CHU Côte de Nacre, Caen, France.
  15. Unité mixte de Recherche 1138, Équipe FunGeS, Institut National de la Santé et de la Recherche médicale, Centre de Recherche des Cordeliers, Université de Paris, Paris, France.
  16. Unité mixte de Recherche S 938, Institut National de la Santé et de la Recherche médicale/CDR Saint-Antoine & Institute of Cardiometabolism and Nutrition, Paris, France.
  17. Unité mixte de Recherche 1149, Centre de Recherche sur l'inflammation, Faculté de Médecine Bichat, Paris, France.

PMID: 34018627 DOI: 10.1002/hep.31913

Abstract

BACKGROUND AND AIMS: Data about the prognosis of salvage transjugular intrahepatic portosystemic shunt (TIPS) using covered stents for refractory variceal bleeding caused by portal hypertension are scarce. We aimed to assess survival and to identify predictors of mortality in these patients.

APPROACH AND RESULTS: One hundred sixty-four patients with cirrhosis from five centers treated with salvage TIPS between 2007 and 2017 were retrospectively divided into a derivation cohort (83 patients) and a validation cohort (81 patients). Comparisons were performed using the Mann-Whitney and Fischer's exact test. Six-week overall survival (OS) was correlated with variables on the day of the TIPS using Kaplan-Meier curves with log-rank test and univariate/multivariate analyses using the Cox model. Eighty-three patients were included in the derivation cohort (male, 78%; age, 55 years, alcohol-associated cirrhosis, 88%; Model for End-Stage Liver Disease [MELD], 19 [15-27]; arterial lactate, 3.7 mmol/L [2.0-8.3]). Six-week OS rate was 58%. At multivariate analysis, the MELD score (OR, 1.064; 95% CI, 1.005-1.126; P = 0.028) and arterial lactate (OR, 1.063; 95% CI, 1.013-1.114; P = 0.032) were associated with 6-week OS. Six-week OS rates were 100% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 5% in patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. The 81 patients of the validation cohort had similar MELD and arterial lactate level but lower creatinine level (94 vs 106 µmol/L, P = 0.008); 6-week OS was 67%. Six-week OS rates were 86% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15 and 10% for patients with lactate ≥12 mmol/L and/or MELD score ≥ 30. In the overall cohort, rebleeding rate was 15.8% at 6 weeks, and the acute-on-chronic liver failure grade (OR, 1.699; 95% CI, 1.056-1.663; P = 0.040) was independently associated with rebleeding.

CONCLUSIONS: After salvage TIPS, 6-week mortality remains high and can be predicted by MELD score and lactate. Survival rate at 6 weeks was >85% in patients with arterial lactate ≤2.5 mmol/L and MELD score ≤ 15, while mortality was >90% for lactate ≥12 mmol/L and/or MELD score ≥ 30.

© 2021 by the American Association for the Study of Liver Diseases.

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