title: Characterization of liver function parameter alterations after transjugular intrahepatic portosystemic shunt creation and association with early mortality.
abstract: OBJECTIVE
  The purpose of this article is to characterize the temporal evolution and clinical impact of laboratory liver function parameters after transjugular intrahepatic portosystemic shunt (TIPS) creation.
  
  
  METHODS
  In this single-institution retrospective study, 157 patients (98 men and 59 women; median age, 55 years) underwent TIPS between 2000 and 2012 and had 1-month hepatobiliary laboratory follow-up. Medical record review was used to compare baseline, peak, and low bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and international normalized ratio (INR) levels within 30 days after TIPS in surviving and dying patients to assess laboratory responses to shunt creation.
  
  
  RESULTS
  TIPSs were created with a hemodynamic success rate of 98%, with median pressure gradient reduction of 13 mm Hg. Ninety-day mortality was 21%. Hepatobiliary laboratory values showed significant increases in the days after TIPS compared with baseline levels (bilirubin, 1.6 vs 3.5 mg/dL; AST, 49 vs 149 U/L; ALT, 26 vs 90 U/L; alkaline phosphatase, 97 vs 177 U/L; and INR, 1.5 vs 2.0; p<0.05 in all cases). Patients surviving to 90 days experienced statistically significant but transient laboratory value elevations-up to twofold over baseline-within days of TIPS, whereas patients dying within 90 days experienced three-to fourfold increases over a longer period that did not return to baseline. Differences in laboratory evolution were statistically significant in surviving versus dying patients.
  
  
  CONCLUSIONS
  TIPS results in acute transient elevation of hepatobiliary enzymes, which may be more pronounced in patients with early mortality. An exaggerated laboratory elevation in excess of threefold greater than baseline or a prolonged increase exceeding 1 week may herald poorer clinical outcome.
authors.affiliation: 1 University of Illinois College of Medicine, Chicago, IL.
authors.forename: Leigh C
authors.initials: LC
authors.lastname: Casadaban
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
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; D000368:Aged; D000369:Aged, 80 and over; D002641:Chicago / Q000453:epidemiology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015994:Incidence; D008111:Liver Function Tests / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055815:Young Adult
keywords: laboratory; liver function parameters; mortality; transjugular intrahepatic portosystemic shunt