Portal Hypertensive Gastropathy and MELD-Na Score Predict Recurrent Gastrointestinal Bleeding After TIPSS: An ALTA Group Study

Advancing Liver Therapeutic Approaches (ALTA) Study Group

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPSS) is highly effective for treatment of variceal bleeding; however, factors contributing to rebleeding complications remain unclear. Aims: In this study, we aim to determine risk factors for recurrent portal hypertensive gastrointestinal bleeding following TIPSS. Methods: Utilising the Advancing Liver Therapeutic Approaches multicentre database, we retrospectively identified adult patients who underwent TIPSS for secondary prophylaxis of variceal bleeding and had a gastrointestinal rebleeding event within 1 year. We developed multivariable logistic regression models to identify clinical/procedural characteristics associated with rebleeding. Results: We identified 476 patients, predominately middle-aged (mean age 57), male (62%) and White (65%), with mean MELD-Na 16. 16% (n = 77) had a rebleeding event; these patients were more likely to be male (p = 0.016), with higher serum creatinine (p = 0.005), MELD-Na (p = 0.0002), portal hypertensive gastropathy on pre-TIPSS upper endoscopy (p = 0.000) and with higher incidence of TIPSS revision (p = 0.000). There were no significant differences in type of TIPSS endoprosthesis, concurrent embolotherapy, and post-TIPSS pressure gradients between those who experienced rebleeding and those who did not. After adjusting for TIPSS revision, multivariable analysis revealed MELD-Na and presence of portal hypertensive gastropathy on pre-TIPSS endoscopy were independently associated with rebleeding. Conclusions: In this retrospective analysis of a multicentre, nationally representative database, we found that apart from TIPSS-related factors, high MELD-Na and portal hypertensive gastropathy on pre-TIPSS endoscopy were independent predictors of rebleeding within 1 year following TIPSS. These variables may be used to identify high-risk patients who may require additional monitoring following TIPSS.

Original languageEnglish (US)
Pages (from-to)346-353
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume61
Issue number2
DOIs
StatePublished - Jan 2025

Funding

This study did not receive direct financial support. The ALTA Study Group, however, is funded by an investigator\u2010initiated grant from W.L. Gore and Associates. The Northwestern Research Electronic Data Capture (REDCap) is funded, in part, by the National Center for Advancing Translational Sciences (NCATS) of the NIH research grant UL1TR001422 to the Northwestern University Clinical and Translational Sciences (NUCATS) Institute. The sponsor (W.L. Gore and Associates) had no input into the overall design and conduct of the ALTA Study. Funding: Drs Justin Boike and Lisa VanWagner receive investigator\u2010initiated grant support from W.L. Gore & Associates. Lisa VanWagner receives consulting fees from Gerson Lehrman Group and Slingshot Insights, and provides expert witness services.

Keywords

  • TIPSS
  • ascites
  • cirrhosis
  • portal hypertension
  • variceal haemorrhage

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

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