title: Transjugular intrahepatic portosystemic shunt placement for refractory ascites: a single-centre experience.
abstract: BACKGROUND
  The presence of refractory ascites is a common indication for transjugular intrahepatic portosystemic shunt (TIPS). Different models have been proposed for the prediction of survival after TIPS. The aim of this study was to evaluate the predictive factors associated with patients' survival after TIPS placement for refractory ascites.
  
  
  METHODS
  Data from all consecutive patients undergoing TIPS placement in our center for refractory ascites between February 2003 and January 2008 were prospectively recorded.
  
  
  RESULTS
  Seventy-three patients (52M/21F; 57 ± 10 years) met the inclusion criteria; mean follow-up was 17 ± 2 months. Mean MELD value, before TIPS placement, was 15.7 ± 5.3. TIPS placement led to an effective resolution of refractory ascites in 54% of patients (n = 40) with no significant increase in severe portosystemic encephalopathy. The 1-year survival rate observed was 65.7%, while the overall mortality was 23.3% (n = 17) with a mean survival of 17 ± 14 months. MELD score (B = 0.161, p = 0.042), basal AST (B = 0.020, p = 0.090), and pre-TIPS HVPG (B = 0.016, p = 0.093) were independent predictors of overall mortality, while MELD (B = 0.419, p = 0.018) and HVPG (B = 0.223, p = 0.060) independently predicted 1-year survival. ROC curves identified MELD ≥ 19 and HVPG ≥ 25 mmHg as the best cut-off points for the prediction of 1-year mortality.
  
  
  CONCLUSIONS
  TIPS is an effective treatment for refractory ascites in cirrhotic patients, leading to an effective ascites control in more than half patients. Improvement in patients' selection criteria could lead to better outcome and survival after this procedure. Liver function (MELD), presence of active necroinflammation (AST), and portal hypertension (HVPG) are independent predictors of patients' outcome after TIPS.
authors.affiliation: Department of Digestive Diseases and Internal Medicine, S. Orsola -Malpighi University Hospital, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lodato
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Lisotti
authors.forename: Francesco
authors.initials: F
authors.lastname: Azzaroli
authors.forename: Cristina
authors.initials: C
authors.lastname: Mosconi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Giampalma
authors.forename: Matteo
authors.initials: M
authors.lastname: Renzulli
authors.forename: Alberta
authors.initials: A
authors.lastname: Cappelli
authors.forename: Federica
authors.initials: F
authors.lastname: Buonfiglioli
authors.forename: Claudio
authors.initials: C
authors.lastname: Calvanese
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.forename: Rita
authors.initials: R
authors.lastname: Golfieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzella
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001201:Ascites / Q000209:etiology / Q000601:surgery*; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D058625:End Stage Liver Disease / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D001219:Aspartate Aminotransferases; D001663:Bilirubin