Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding

Marika Rudler; Virginia Hernández-Gea; Bogdan Dumitru Procopet; Alvaro Giráldez; Lucio Amitrano; Càndid Villanueva; Luis Ibañez; Gilberto Silva-Junior; Joan Genesca; Christophe Bureau; Jonel Trebicka; Rafael Bañares; Aleksander Krag; Elba Llop; Wim Laleman; Jose Maria Palazon; Jose Castellote; Susana Rodrigues; Lise Lotte Gluud; Carlos Noronha Ferreira; Nouria Canete; Manuel Rodríguez; Arnulf Ferlitsch; Jose Luis Mundi; Henning Gronbaek; Manuel Hernandez-Guerra; Romano Sassatelli; Alessandra Dell'Era; Marco Senzolo; Juan G. Abraldes; Manuel Romero-Gómez; Alexander Zipprich; Meritxell Casas; Helena Masnou; Hélène Larrue; Massimo Primignani; Frederik Nevens; Jose Luis Calleja; Remy Schwarzer; Christian Jansen; Marie Angèle Robic; Irene Conejo; Javier Martínez Gonzalez; Maria Vega Catalina; Agustín Albillos; Edilmar Alvarado; Maria Anna Guardascione; Maxime Mallet; Simona Tripon; Georgina Casanovas; Jaume Bosch; Juan Carlos Garcia-Pagan; Dominique Thabut

doi:10.1136/gutjnl-2022-326975

Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding

Marika Rudler^*, Virginia Hernández-Gea, Bogdan Dumitru Procopet, Alvaro Giráldez, Lucio Amitrano, Càndid Villanueva, Luis Ibañez, Gilberto Silva-Junior, Joan Genesca, Christophe Bureau, Jonel Trebicka, Rafael Bañares, Aleksander Krag, Elba Llop, Wim Laleman, Jose Maria Palazon, Jose Castellote, Susana Rodrigues, Lise Lotte Gluud, Carlos Noronha FerreiraNouria Canete, Manuel Rodríguez, Arnulf Ferlitsch, Jose Luis Mundi, Henning Gronbaek, Manuel Hernandez-Guerra, Romano Sassatelli, Alessandra Dell'Era, Marco Senzolo, Juan G. Abraldes, Manuel Romero-Gómez, Alexander Zipprich, Meritxell Casas, Helena Masnou, Hélène Larrue, Massimo Primignani, Frederik Nevens, Jose Luis Calleja, Remy Schwarzer, Christian Jansen, Marie Angèle Robic, Irene Conejo, Javier Martínez Gonzalez, Maria Vega Catalina, Agustín Albillos, Edilmar Alvarado, Maria Anna Guardascione, Maxime Mallet, Simona Tripon, Georgina Casanovas, Jaume Bosch, Juan Carlos Garcia-Pagan, Dominique Thabut

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Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

Background: A pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that <15% of patients eligible for pTIPS ultimately undergo transjugular intrahepatic portosystemic shunt (TIPS) due to concerns about hepatic encephalopathy (HE). The outcome of patients undergoing pTIPS with HE is unknown. We aimed to (1) assess the prevalence of HE in patients with AVB; (2) evaluate the outcome of patients presenting HE at admission after pTIPS; and (3) determine if HE at admission is a risk factor for death and post-TIPS HE. Patients and methods: This is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation. Results: 671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p<0.001). In high-risk patients with HE at admission, pTIPS was associated with a lower 1-year mortality than endoscopic+drug (HR 0.374, 95% CI 0.166 to 0.845, p=0.0181). The incidence of HE was not different between patients treated with pTIPS and endoscopic+drug (38.2% vs 38.7%, p=0.9721), even in patients with HE at admission (56.4% vs 58.7%, p=0.4594). Age >56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients. Conclusion: pTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.

Originalsprog	Engelsk
Tidsskrift	GUT
Vol/bind	72
Udgave nummer	4
Sider (fra-til)	749-758
ISSN	0017-5749
DOI	https://doi.org/10.1136/gutjnl-2022-326975
Status	Udgivet - apr. 2023

Bibliografisk note

Funding Information:
CB has received speaker fees from GORE and is a board member in Alfa Wassemran/Norgine. VH-G, AG, JB, AA, DT and FN have received speaker fees from GORE. J-CG-P has consultant fees from GORE, and Shionogi and Cook grants from GORE and Novartis. JT has speaking and/or consulting fees from GORE, Bayer, Alexion, MSD, Gilead, Intercept, Norgine, Grifols, Versantis and Martin Pharmaceuticals. RB has received speaker fees from GORE and Grifols, unrelated to the submitted work.

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Dokumenter og links

10.1136/gutjnl-2022-326975

Citationsformater

Rudler, M., Hernández-Gea, V., Procopet, B. D., Giráldez, A., Amitrano, L., Villanueva, C., Ibañez, L., Silva-Junior, G., Genesca, J., Bureau, C., Trebicka, J., Bañares, R., Krag, A., Llop, E., Laleman, W., Palazon, J. M., Castellote, J., Rodrigues, S., Gluud, L. L., ... Thabut, D. (2023). Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding. GUT, 72(4), 749-758. https://doi.org/10.1136/gutjnl-2022-326975

@article{3a67764770704f50a98c37bd2c7448a5,

title = "Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding",

abstract = "Background: A pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that <15% of patients eligible for pTIPS ultimately undergo transjugular intrahepatic portosystemic shunt (TIPS) due to concerns about hepatic encephalopathy (HE). The outcome of patients undergoing pTIPS with HE is unknown. We aimed to (1) assess the prevalence of HE in patients with AVB; (2) evaluate the outcome of patients presenting HE at admission after pTIPS; and (3) determine if HE at admission is a risk factor for death and post-TIPS HE. Patients and methods: This is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation. Results: 671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p<0.001). In high-risk patients with HE at admission, pTIPS was associated with a lower 1-year mortality than endoscopic+drug (HR 0.374, 95% CI 0.166 to 0.845, p=0.0181). The incidence of HE was not different between patients treated with pTIPS and endoscopic+drug (38.2% vs 38.7%, p=0.9721), even in patients with HE at admission (56.4% vs 58.7%, p=0.4594). Age >56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients. Conclusion: pTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.",

keywords = "cirrhosis, hepatic encephalopathy, oesophageal varices, Liver Cirrhosis/complications, Severity of Illness Index, End Stage Liver Disease, Humans, Hepatic Encephalopathy/etiology, Esophageal and Gastric Varices/complications, Gastrointestinal Hemorrhage/etiology, Contraindications",

author = "Marika Rudler and Virginia Hern{\'a}ndez-Gea and Procopet, {Bogdan Dumitru} and Alvaro Gir{\'a}ldez and Lucio Amitrano and C{\`a}ndid Villanueva and Luis Iba{\~n}ez and Gilberto Silva-Junior and Joan Genesca and Christophe Bureau and Jonel Trebicka and Rafael Ba{\~n}ares and Aleksander Krag and Elba Llop and Wim Laleman and Palazon, {Jose Maria} and Jose Castellote and Susana Rodrigues and Gluud, {Lise Lotte} and {Noronha Ferreira}, Carlos and Nouria Canete and Manuel Rodr{\'i}guez and Arnulf Ferlitsch and Mundi, {Jose Luis} and Henning Gronbaek and Manuel Hernandez-Guerra and Romano Sassatelli and Alessandra Dell'Era and Marco Senzolo and Abraldes, {Juan G.} and Manuel Romero-G{\'o}mez and Alexander Zipprich and Meritxell Casas and Helena Masnou and H{\'e}l{\`e}ne Larrue and Massimo Primignani and Frederik Nevens and Calleja, {Jose Luis} and Remy Schwarzer and Christian Jansen and Robic, {Marie Ang{\`e}le} and Irene Conejo and {Mart{\'i}nez Gonzalez}, Javier and Catalina, {Maria Vega} and Agust{\'i}n Albillos and Edilmar Alvarado and Guardascione, {Maria Anna} and Maxime Mallet and Simona Tripon and Georgina Casanovas and Jaume Bosch and Garcia-Pagan, {Juan Carlos} and Dominique Thabut",

note = "Funding Information: CB has received speaker fees from GORE and is a board member in Alfa Wassemran/Norgine. VH-G, AG, JB, AA, DT and FN have received speaker fees from GORE. J-CG-P has consultant fees from GORE, and Shionogi and Cook grants from GORE and Novartis. JT has speaking and/or consulting fees from GORE, Bayer, Alexion, MSD, Gilead, Intercept, Norgine, Grifols, Versantis and Martin Pharmaceuticals. RB has received speaker fees from GORE and Grifols, unrelated to the submitted work. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

month = apr,

doi = "10.1136/gutjnl-2022-326975",

language = "English",

volume = "72",

pages = "749--758",

journal = "GUT",

issn = "0017-5749",

publisher = "B M J Group",

number = "4",

}

Rudler, M, Hernández-Gea, V, Procopet, BD, Giráldez, A, Amitrano, L, Villanueva, C, Ibañez, L, Silva-Junior, G, Genesca, J, Bureau, C, Trebicka, J, Bañares, R, Krag, A, Llop, E, Laleman, W, Palazon, JM, Castellote, J, Rodrigues, S, Gluud, LL, Noronha Ferreira, C, Canete, N, Rodríguez, M, Ferlitsch, A, Mundi, JL, Gronbaek, H, Hernandez-Guerra, M, Sassatelli, R, Dell'Era, A, Senzolo, M, Abraldes, JG, Romero-Gómez, M, Zipprich, A, Casas, M, Masnou, H, Larrue, H, Primignani, M, Nevens, F, Calleja, JL, Schwarzer, R, Jansen, C, Robic, MA, Conejo, I, Martínez Gonzalez, J, Catalina, MV, Albillos, A, Alvarado, E, Guardascione, MA, Mallet, M, Tripon, S, Casanovas, G, Bosch, J, Garcia-Pagan, JC & Thabut, D 2023, 'Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding', GUT, bind 72, nr. 4, s. 749-758. https://doi.org/10.1136/gutjnl-2022-326975

TY - JOUR

T1 - Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding

AU - Rudler, Marika

AU - Hernández-Gea, Virginia

AU - Procopet, Bogdan Dumitru

AU - Giráldez, Alvaro

AU - Amitrano, Lucio

AU - Villanueva, Càndid

AU - Ibañez, Luis

AU - Silva-Junior, Gilberto

AU - Genesca, Joan

AU - Bureau, Christophe

AU - Trebicka, Jonel

AU - Bañares, Rafael

AU - Krag, Aleksander

AU - Llop, Elba

AU - Laleman, Wim

AU - Palazon, Jose Maria

AU - Castellote, Jose

AU - Rodrigues, Susana

AU - Gluud, Lise Lotte

AU - Noronha Ferreira, Carlos

AU - Canete, Nouria

AU - Rodríguez, Manuel

AU - Ferlitsch, Arnulf

AU - Mundi, Jose Luis

AU - Gronbaek, Henning

AU - Hernandez-Guerra, Manuel

AU - Sassatelli, Romano

AU - Dell'Era, Alessandra

AU - Senzolo, Marco

AU - Abraldes, Juan G.

AU - Romero-Gómez, Manuel

AU - Zipprich, Alexander

AU - Casas, Meritxell

AU - Masnou, Helena

AU - Larrue, Hélène

AU - Primignani, Massimo

AU - Nevens, Frederik

AU - Calleja, Jose Luis

AU - Schwarzer, Remy

AU - Jansen, Christian

AU - Robic, Marie Angèle

AU - Conejo, Irene

AU - Martínez Gonzalez, Javier

AU - Catalina, Maria Vega

AU - Albillos, Agustín

AU - Alvarado, Edilmar

AU - Guardascione, Maria Anna

AU - Mallet, Maxime

AU - Tripon, Simona

AU - Casanovas, Georgina

AU - Bosch, Jaume

AU - Garcia-Pagan, Juan Carlos

AU - Thabut, Dominique

N1 - Funding Information: CB has received speaker fees from GORE and is a board member in Alfa Wassemran/Norgine. VH-G, AG, JB, AA, DT and FN have received speaker fees from GORE. J-CG-P has consultant fees from GORE, and Shionogi and Cook grants from GORE and Novartis. JT has speaking and/or consulting fees from GORE, Bayer, Alexion, MSD, Gilead, Intercept, Norgine, Grifols, Versantis and Martin Pharmaceuticals. RB has received speaker fees from GORE and Grifols, unrelated to the submitted work. Publisher Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023/4

Y1 - 2023/4

N2 - Background: A pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that <15% of patients eligible for pTIPS ultimately undergo transjugular intrahepatic portosystemic shunt (TIPS) due to concerns about hepatic encephalopathy (HE). The outcome of patients undergoing pTIPS with HE is unknown. We aimed to (1) assess the prevalence of HE in patients with AVB; (2) evaluate the outcome of patients presenting HE at admission after pTIPS; and (3) determine if HE at admission is a risk factor for death and post-TIPS HE. Patients and methods: This is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation. Results: 671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p<0.001). In high-risk patients with HE at admission, pTIPS was associated with a lower 1-year mortality than endoscopic+drug (HR 0.374, 95% CI 0.166 to 0.845, p=0.0181). The incidence of HE was not different between patients treated with pTIPS and endoscopic+drug (38.2% vs 38.7%, p=0.9721), even in patients with HE at admission (56.4% vs 58.7%, p=0.4594). Age >56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients. Conclusion: pTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.

AB - Background: A pre-emptive transjugular intrahepatic portosystemic shunt (pTIPS) reduces mortality in high-risk patients with cirrhosis (Child-Pugh C/B+active bleeding) with acute variceal bleeding (AVB). Real-life studies point out that <15% of patients eligible for pTIPS ultimately undergo transjugular intrahepatic portosystemic shunt (TIPS) due to concerns about hepatic encephalopathy (HE). The outcome of patients undergoing pTIPS with HE is unknown. We aimed to (1) assess the prevalence of HE in patients with AVB; (2) evaluate the outcome of patients presenting HE at admission after pTIPS; and (3) determine if HE at admission is a risk factor for death and post-TIPS HE. Patients and methods: This is an observational study including 2138 patients from 34 centres between October 2011 and May 2015. Placement of pTIPS was based on individual centre policy. Patients were followed up to 1 year, death or liver transplantation. Results: 671 of 2138 patients were considered at high risk, 66 received pTIPS and 605 endoscopic+drug treatment. At admission, HE was significantly more frequent in high-risk than in low-risk patients (39.2% vs 10.6%, p<0.001). In high-risk patients with HE at admission, pTIPS was associated with a lower 1-year mortality than endoscopic+drug (HR 0.374, 95% CI 0.166 to 0.845, p=0.0181). The incidence of HE was not different between patients treated with pTIPS and endoscopic+drug (38.2% vs 38.7%, p=0.9721), even in patients with HE at admission (56.4% vs 58.7%, p=0.4594). Age >56, shock, Model for End-Stage Liver Disease score >15, endoscopic+drug treatment and HE at admission were independent factors of death in high-risk patients. Conclusion: pTIPS is associated with better survival than endoscopic treatment in high-risk patients with cirrhosis with variceal bleeding displaying HE at admission.

KW - cirrhosis

KW - hepatic encephalopathy

KW - oesophageal varices

KW - Liver Cirrhosis/complications

KW - Severity of Illness Index

KW - End Stage Liver Disease

KW - Humans

KW - Hepatic Encephalopathy/etiology

KW - Esophageal and Gastric Varices/complications

KW - Gastrointestinal Hemorrhage/etiology

KW - Contraindications

U2 - 10.1136/gutjnl-2022-326975

DO - 10.1136/gutjnl-2022-326975

M3 - Journal article

C2 - 36328772

AN - SCOPUS:85139230191

SN - 0017-5749

VL - 72

SP - 749

EP - 758

JO - GUT

JF - GUT

IS - 4

ER -

Hepatic encephalopathy is not a contraindication to pre-emptive TIPS in high-risk patients with cirrhosis with variceal bleeding

Abstract

Bibliografisk note

Dokumenter og links

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Citationsformater