Prognostic impact of renal impairment and sodium imbalance in patients undergoing transjugular intrahepatic portosystemic shunting for the prevention of variceal rebleeding.
OBJECTIVE
Kidney function and portal pressure have prognostic relevance in nonshunted patients with cirrhosis. Since insertion of a transjugular intrahepatic portosystemic shunt (TIPS) reduces portal pressure and may improve the renal function, the aim of the present study was to investigate the prognostic role of renal impairment and portal hemodynamics in patients with compensated cirrhosis electively shunted due to recurrent variceal hemorrhages.


METHODS
Data of 101 consecutive and prospectively followed patients with compensated cirrhosis (bilirubin <5 mg/dl) undergoing elective TIPS due to recurrent variceal bleeding (45 died, and 8 were transplanted during the follow-up period) were evaluated in a multivariate Cox model.


RESULTS
Creatinine and sodium were identified as the only independent predictors of survival in this model. The 90th percentile of creatinine (>1.7 mg/dl) defined a subgroup with a similar poor prognosis as the 90th percentile of the model for end-stage liver disease (MELD) score. Neither baseline nor post-TIPS portal pressure correlated with the long-term outcome.


CONCLUSIONS
In compensated patients undergoing TIPS due to variceal bleeding, renal impairment indicates a poor prognosis. Portal hemodynamic parameters are not predictive of survival in TIPS patients.
Schepke
Michael
M
Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Roth
Felix
F
Koch
Lydia
L
Heller
Jörg
J
Rabe
Christian
C
Brensing
Karl-August
KA
Schiedermaier
Peter
P
Schild
Hans H
HH
Sauerbruch
Tilman
T
D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007010:Hyponatremia / Q000209:etiology / Q000401:mortality*; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality*; D055502:Secondary Prevention