title: What constitutes liver failure after transjugular intrahepatic portosystemic shunt creation? A proposed definition and grading system.
abstract: Background and rationale for the study. There is currently no definition of post-transjugular intrahepatic portosystemic shunt (TIPS) liver failure (PTLF), which constitutes a barrier to standardization of TIPS results reporting and limits the ability to compare liver failure incidence across clinical studies. Thisdescriptive study proposes and preliminarily tests the performance of a PTLF definition and grading system.
  
  
  RESULTS
  PTLF was defined by ≥ 3-fold bilirubin and/or ≥ 2-fold INR elevation associated with clinical outcomes of prolonged hospitalization/increase in care level (grade 1), TIPS reduction or liver transplantation (grade 2), or death (grade 3) within 30-days of TIPS. PTLF incidence was 20% (grades 1, 2, 3: 10%, 3%, 8%) among 270 TIPS cases, and the scheme identified patients at increased risk for morbidity and mortality with a statistically significant difference in clinical outcomes between PTLF and non-PTLF groups (P<0.0001).
  
  
  CONCLUSIONS
  In conclusion, the PTLF definition and classification scheme put forth distributes patients into unique risk groups. PTLF grading may thus be useful for standardization of TIPS results reporting.
authors: University of Illinois Hospital and Health Sciences System, Department of Radiology, Division of Interventional Radiology. Chicago, IL, USA.
authors: Ron C
authors: RC
authors: Gaba
authors: University of Illinois Hospital and Health Sciences System, Department of Radiology, Division of Interventional Radiology. Chicago, IL, USA.
authors: Janesh
authors: J
authors: Lakhoo
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D001778:Blood Coagulation Disorders / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006501:Hepatic Encephalopathy; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D015994:Incidence; D019934:International Normalized Ratio; D017093:Liver Failure / Q000097:blood / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications / Q000097:blood / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D001663:Bilirubin