title: Prophylactic use of transjugular intrahepatic portosystemic shunt aids in the treatment of refractory ascites: metaregression and trial sequential meta-analysis.
abstract: OBJECTIVE
  The aim of this study was to explore whether prophylactic use of transjugular intrahepatic portosystemic shunt (TIPS) could aid in the treatment of refractory ascites on the basis of current randomized controlled trials.
  
  
  BACKGROUND
  TIPS is more effective for refractory ascites versus large-volume paracentesis. At present, however, the survival advantage is not clear within populations of undifferentiated patients.
  
  
  METHODS
  Correlative studies were searched through online journal databases, and a manual search was done from 1974 to 2012. Six trials involving 390 patients were included.
  
  
  RESULTS
  TIPS could ameliorate refractory ascites on the basis of short-term analysis [odds ratio (OR) 8.66; 95% confidence interval (CI), 5.27-14.24] and long-term analysis (OR 6.07; 95% CI, 3.60-10.22). Hepatic encephalopathy (HE) appeared more common in the TIPS arm (OR 2.95; 95% CI, 1.87-4.66). Mortality in the 2 groups did not show any difference (OR 0.82; 95% CI, 0.46-1.50). Trial sequential analysis confirmed the effect of TIPS upon ascites control and upon the risk of HE recurrence, whereas insufficient trials were available to distinguish between the arms on mortality. Metaregression analysis showed that the level of urine sodium, serum bilirubin, and portal pressure gradient reduction value could be used as survival predictors. Subgroup analysis showed an elevated survival effect in TIPS (OR 0.45; 95% CI, 0.24-0.81), and patients survived longer with recurrent ascites (OR 0.40; 95% CI, 0.19-0.83).
  
  
  CONCLUSIONS
  TIPS was confirmed to improve ascites control in both the short term and the long term. Although HE frequently appeared in the TIPS group, patients with better hepatic and renal function survived longer when they were treated with TIPS. Serum bilirubin and urine sodium could be used as pre-TIPS predictors for patient survival. Portal pressure gradient reduction values could be used as post-TIPS predictors of survival.
authors.affiliation: Departments of *Gastroenterology and Hepatology †Gastrointestinal Surgery, First Affiliated Hospital of Wenzhou Medical College ‡School of International Studies, Wenzhou Medical College, Wenzhou, China.
authors.forename: Ren Pin
authors.initials: RP
authors.lastname: Chen
authors.forename: Xiao Ju
authors.initials: XJ
authors.lastname: Zhu Ge
authors.forename: Zhi Ming
authors.initials: ZM
authors.lastname: Huang
authors.forename: Xiao Hua
authors.initials: XH
authors.lastname: Ye
authors.forename: Chang Yuan
authors.initials: CY
authors.lastname: Hu
authors.forename: Guang Rong
authors.initials: GR
authors.lastname: Lu
authors.forename: De Yi
authors.initials: DY
authors.lastname: Lu
authors.forename: Igor Longe
authors.initials: IL
authors.lastname: Phemba
mesh_terms: D001201:Ascites / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D006801:Humans; D016017:Odds Ratio; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers