title: Older patient age may predict early mortality after transjugular intrahepatic portosystemic shunt creation in individuals at intermediate risk.
abstract: OBJECTIVE
  To identify prognostic factors for early mortality among patients with intermediate-risk Model for End-stage Liver Disease (MELD) scores undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation.
  
  
  METHODS
  In this single-institution retrospective study, 47 patients (31 men; mean age, 54 y) with intermediate MELD scores (ie, 18-25) underwent TIPS creation between 1999 and 2012. Medical records were reviewed to identify demographic (age, sex), liver disease (Child-Pugh, MELD), and procedure data (indication, urgency, stent type, portosystemic pressure gradient reduction, complications), and the influence of these parameters on 90-day mortality was assessed by multivariate binary logistic regression analysis.
  
  
  RESULTS
  TIPSs were successfully created for variceal hemorrhage (n = 24), ascites (n = 17), hydrothorax (n = 5), and portal vein thrombosis (n = 1). Hemodynamic success rate was 94% (44 of 47), and mean portosystemic pressure gradient reduction was 13 mm Hg. The 90-day mortality rate was 36% (17 of 47). Patient age (P = .026) was significantly associated with 90-day mortality. Mean ages of living versus dead patients were 51 and 60 years, and mortality rates in patients aged 54 years or younger versus 55 years or older were 21% (five of 24) and 52% (12 of 23), respectively. There was no difference in MELD scores between these age groups (20.6 vs 21.0; P = .600), and MELD score was not a predictive factor on regression analysis.
  
  
  CONCLUSIONS
  Age is a prognostic factor for early mortality in TIPS recipients with intermediate MELD scores. Mortality rates are higher in patients at least 55 years of age, but MELD score does not predict survival in this subset. Age should be contemplated when selecting patients at intermediate risk for TIPS creation.
authors.affiliation: Department of Radiology/Section of Interventional Radiology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
authors.forename: Kruti D
authors.initials: KD
authors.lastname: Shah
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Couture
authors.forename: Jeet
authors.initials: J
authors.lastname: Minocha
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D002641:Chicago; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome