Factors affecting immediate and long-term survival after emergent and elective splanchnic-systemic shunts.
The course of 121 shunted cirrhotic patients, managed according to a prospective protocol over a period of 10 years, was analyzed to determine predictors of 30-day and long-term survival. Forty-five per cent of the patients underwent emergent decompression within 12 hours of active bleeding, and 34% of the shunts were selective. Logistic regression linked early mortality to bilirubin and blood-urea nitrogen (BUN) (p = 0.001), and long-term survival to the presence of preoperative ascites and higher levels of alkaline phosphatase (p = 0.027), but neither variable set was a more accurate predictor than Child Class. Emergency shunt patients had greater risk of early death, 44% vs. 17% for patients shunted electively (p = 0.001), but beyond 30 days, their Kaplan-Meier survival curves were identical. Independently, angiographic prograde portal flow was favorably associated with short-term (p = 0.003) but not prolonged survival. The presence of Mallory bodies, fatty metamorphosis, and acute periportal inflammation, alone or in combination, had no prognostic value. Continued post-operative alcohol ingestion jeopardized long-term survival (p = 0.017). Survival of nonalcoholics was enhanced by selective as opposed to total splanchnic decompression (p = 0.009).
D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D013514:Surgical Procedures, Operative / Q000401:mortality*; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery