Risk of portal hypertensive complications preventable by TIPS in patients with ascites
Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of recurrent/refractory ascites in patients with cirrhosis. The aim of this study is to identify patients with ascites as index decompensation who are at risk of developing portal hypertension (...
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Elsevier
2025-08-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555925001478 |
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| author | Lorenz Balcar Marta Tonon Joan Valls Valeria Calvino Lucie Simonis Jan Embacher Roberta Gagliardi Christian Sebesta Leonie Hafner Antonio Accetta Lukas Hartl Mattias Mandorfer Michael Trauner Paolo Angeli Thomas Reiberger Juan Carlos García-Pagán Georg Semmler Salvatore Piano |
| author_facet | Lorenz Balcar Marta Tonon Joan Valls Valeria Calvino Lucie Simonis Jan Embacher Roberta Gagliardi Christian Sebesta Leonie Hafner Antonio Accetta Lukas Hartl Mattias Mandorfer Michael Trauner Paolo Angeli Thomas Reiberger Juan Carlos García-Pagán Georg Semmler Salvatore Piano |
| author_sort | Lorenz Balcar |
| collection | DOAJ |
| description | Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of recurrent/refractory ascites in patients with cirrhosis. The aim of this study is to identify patients with ascites as index decompensation who are at risk of developing portal hypertension (PH)-related complications within 12 months that seem preventable by TIPS. Methods: We included 451 patients from two tertiary care centres (Vienna and Padua, derivation cohort) with clinically significant ascites (grade 2/3) as a single first decompensating event and without contraindications for TIPS placement. Multivariable logistic regression analysis was used to identify variables independently associated with a composite endpoint of PH-related complications (encephalopathy excluded), liver transplantation, or liver-related death. A classification tree was used to identify patients at highest risk for these PH-related complications. Risk estimates were validated in a temporal validation cohort from Vienna (n = 84). Results: In the derivation cohort (mean age 56 ± 11 years; 69% male; 51% alcohol-related cirrhosis; 44% ascites grade 3; median model for end-stage liver disease [MELD] 12 points), 152 (34%) patients developed the composite endpoint within 12 months. A model including ascites grade, sodium, and MELD accurately predicted the occurrence of this composite endpoint (area under the receiver operator characteristics curve: 0.79 [95% CI: 0.75–0.84]). Two high-risk clusters were identified: patients with grade 3 ascites and either (i) sodium ≤135 mmol/L, or (ii) MELD ≥12 points, with a pooled absolute risk of 64.3% (derivation cohort) and 68.9% (validation cohort) to develop the composite endpoint. Conclusions: Patients with first decompensation caused by ascites grade 3 and either sodium ≤135 mmol/L or MELD ≥12 are at high risk for PH-related complications that are likely preventable by early TIPS placement. A trial investigating ‘early’ TIPS in this at-risk population is warranted. Impact and implications: We identified ascites grade, sodium, and model for end-stage liver disease (MELD) as key predictors of portal hypertension-related complications that may be preventable by TIPS in patients with ascites. Specifically, patients with ascites grade 3 and either sodium ≤135 mmol/L or MELD ≥12 are at risk to experience early clinical deterioration and may benefit from TIPS. A trial investigating ‘early’ TIPS in this at-risk population is warranted. |
| format | Article |
| id | doaj-art-3c097865dcc04119be8aead5e45f3490 |
| institution | OA Journals |
| issn | 2589-5559 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| spelling | doaj-art-3c097865dcc04119be8aead5e45f34902025-08-20T02:36:16ZengElsevierJHEP Reports2589-55592025-08-017810146910.1016/j.jhepr.2025.101469Risk of portal hypertensive complications preventable by TIPS in patients with ascitesLorenz Balcar0Marta Tonon1Joan Valls2Valeria Calvino3Lucie Simonis4Jan Embacher5Roberta Gagliardi6Christian Sebesta7Leonie Hafner8Antonio Accetta9Lukas Hartl10Mattias Mandorfer11Michael Trauner12Paolo Angeli13Thomas Reiberger14Juan Carlos García-Pagán15Georg Semmler16Salvatore Piano17Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaUnit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padua, ItalyBarcelona Clinical Coordinating Center, Barcelona, Spain; Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, SpainUnit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padua, ItalyDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaUnit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padua, ItalyDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaUnit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padua, ItalyDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaUnit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padua, ItalyDivision of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, AustriaBarcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBEREHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), Departament de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain; Departament de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain; Corresponding author. Address: Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Villarroel 170, Barcelona 08036, Catalonia, Spain. Tel.: +34-932-275-400 (x5790), Fax: +34-932-279-856.Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Center of Liver Research (FLASH), Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, DenmarkUnit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padua, ItalyBackground & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of recurrent/refractory ascites in patients with cirrhosis. The aim of this study is to identify patients with ascites as index decompensation who are at risk of developing portal hypertension (PH)-related complications within 12 months that seem preventable by TIPS. Methods: We included 451 patients from two tertiary care centres (Vienna and Padua, derivation cohort) with clinically significant ascites (grade 2/3) as a single first decompensating event and without contraindications for TIPS placement. Multivariable logistic regression analysis was used to identify variables independently associated with a composite endpoint of PH-related complications (encephalopathy excluded), liver transplantation, or liver-related death. A classification tree was used to identify patients at highest risk for these PH-related complications. Risk estimates were validated in a temporal validation cohort from Vienna (n = 84). Results: In the derivation cohort (mean age 56 ± 11 years; 69% male; 51% alcohol-related cirrhosis; 44% ascites grade 3; median model for end-stage liver disease [MELD] 12 points), 152 (34%) patients developed the composite endpoint within 12 months. A model including ascites grade, sodium, and MELD accurately predicted the occurrence of this composite endpoint (area under the receiver operator characteristics curve: 0.79 [95% CI: 0.75–0.84]). Two high-risk clusters were identified: patients with grade 3 ascites and either (i) sodium ≤135 mmol/L, or (ii) MELD ≥12 points, with a pooled absolute risk of 64.3% (derivation cohort) and 68.9% (validation cohort) to develop the composite endpoint. Conclusions: Patients with first decompensation caused by ascites grade 3 and either sodium ≤135 mmol/L or MELD ≥12 are at high risk for PH-related complications that are likely preventable by early TIPS placement. A trial investigating ‘early’ TIPS in this at-risk population is warranted. Impact and implications: We identified ascites grade, sodium, and model for end-stage liver disease (MELD) as key predictors of portal hypertension-related complications that may be preventable by TIPS in patients with ascites. Specifically, patients with ascites grade 3 and either sodium ≤135 mmol/L or MELD ≥12 are at risk to experience early clinical deterioration and may benefit from TIPS. A trial investigating ‘early’ TIPS in this at-risk population is warranted.http://www.sciencedirect.com/science/article/pii/S2589555925001478CirrhosisAscitesTIPSPortal hypertension |
| spellingShingle | Lorenz Balcar Marta Tonon Joan Valls Valeria Calvino Lucie Simonis Jan Embacher Roberta Gagliardi Christian Sebesta Leonie Hafner Antonio Accetta Lukas Hartl Mattias Mandorfer Michael Trauner Paolo Angeli Thomas Reiberger Juan Carlos García-Pagán Georg Semmler Salvatore Piano Risk of portal hypertensive complications preventable by TIPS in patients with ascites JHEP Reports Cirrhosis Ascites TIPS Portal hypertension |
| title | Risk of portal hypertensive complications preventable by TIPS in patients with ascites |
| title_full | Risk of portal hypertensive complications preventable by TIPS in patients with ascites |
| title_fullStr | Risk of portal hypertensive complications preventable by TIPS in patients with ascites |
| title_full_unstemmed | Risk of portal hypertensive complications preventable by TIPS in patients with ascites |
| title_short | Risk of portal hypertensive complications preventable by TIPS in patients with ascites |
| title_sort | risk of portal hypertensive complications preventable by tips in patients with ascites |
| topic | Cirrhosis Ascites TIPS Portal hypertension |
| url | http://www.sciencedirect.com/science/article/pii/S2589555925001478 |
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