What constitutes liver failure after transjugular intrahepatic portosystemic shunt creation? A proposed definition and grading system.

Abstract

UNLABELLED:

 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: Ron C Gaba, Janesh Lakhoo
• Journal: Annals of hepatology (Ann Hepatol) 2016 Mar-Apr Vol. 15 Issue 2 Pg. 230-5 ISSN: 1665-2681 [Print] Mexico
• PMID: 26845600 (Publication Type: Journal Article)

Chemical References

• Bilirubin

Topics

• Aged
• Bilirubin (blood)
• Blood Coagulation Disorders (blood)
• Cohort Studies
• Female
• Hepatic Encephalopathy
• Humans
• Hypertension, Portal (surgery)
• Incidence
• International Normalized Ratio
• Liver Failure (blood, classification, diagnosis, epidemiology)
• Liver Transplantation
• Male
• Middle Aged
• Portasystemic Shunt, Transjugular Intrahepatic
• Postoperative Complications (blood, classification, diagnosis, epidemiology)
• Retrospective Studies
• Severity of Illness Index