TY - JOUR
T1 - Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis
AU - Praktiknjo, Michael
AU - Simón-Talero, Macarena
AU - Römer, Julia
AU - Roccarina, Davide
AU - Martínez, Javier
AU - Lampichler, Katharina
AU - Baiges, Anna
AU - Low, Gavin
AU - Llop, Elba
AU - Maurer, Martin H.
AU - Zipprich, Alexander
AU - Triolo, Michela
AU - Maleux, Geert
AU - Fialla, Annette Dam
AU - Dam, Claus
AU - Vidal-González, Judit
AU - Majumdar, Avik
AU - Picón, Carmen
AU - Toth, Daniel
AU - Darnell, Anna
AU - Abraldes, Juan G.
AU - López, Marta
AU - Jansen, Christian
AU - Chang, Johannes
AU - Schierwagen, Robert
AU - Uschner, Frank
AU - Kukuk, Guido
AU - Meyer, Carsten
AU - Thomas, Daniel
AU - Wolter, Karsten
AU - Strassburg, Christian P.
AU - Laleman, Wim
AU - La Mura, Vincenzo
AU - Ripoll, Cristina
AU - Berzigotti, Annalisa
AU - Calleja, José Luis
AU - Tandon, Puneeta
AU - Hernandez-Gea, Virginia
AU - Reiberger, Thomas
AU - Albillos, Agustín
AU - Tsochatzis, Emmanuel A.
AU - Krag, Aleksander
AU - Genescà, Joan
AU - Trebicka, Jonel
AU - Baveno VI (Baveno Cooperation)
PY - 2020/6
Y1 - 2020/6
N2 - BACKGROUND & AIMS: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis.METHODS: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint.RESULTS: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm
2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02-2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA.
CONCLUSION: This study suggests that TSA >83 mm
2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis.
LAY SUMMARY: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.
AB - BACKGROUND & AIMS: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis.METHODS: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint.RESULTS: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm
2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02-2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA.
CONCLUSION: This study suggests that TSA >83 mm
2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis.
LAY SUMMARY: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.
KW - ACLF
KW - Acute decompensation
KW - Acute-on-chronic liver failure
KW - Ascites
KW - Cirrhosis
KW - Computed tomography
KW - Hepatic encephalopathy
KW - Liver
KW - Portal hypertension
KW - Spontaneous portosystemic shunt
KW - SPSS
KW - TIPS
U2 - 10.1016/j.jhep.2019.12.021
DO - 10.1016/j.jhep.2019.12.021
M3 - Journal article
C2 - 31954206
AN - SCOPUS:85081204806
SN - 0168-8278
VL - 72
SP - 1140
EP - 1150
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 6
ER -