Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention
Background. Endoscopic therapy is the first-line treatment of choice for control of acute variceal bleeding (AVB). In high-risk patients with persistent AVB despite pharmacological treatment and endoscopic intervention, percutaneous transjugular intrahepatic portosystemic shunting (TIPS) pr...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
South African Medical Association
2023-12-01
|
| Series: | South African Medical Journal |
| Subjects: | |
| Online Access: | https://samajournals.co.za/index.php/samj/article/view/1839 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823860563696943104 |
|---|---|
| author | J E J Krige E G Jonas M Setshedi S J Beningfield U K Lotze M M Bernon S Burmeister J C Kloppers |
| author_facet | J E J Krige E G Jonas M Setshedi S J Beningfield U K Lotze M M Bernon S Burmeister J C Kloppers |
| author_sort | J E J Krige |
| collection | DOAJ |
| description |
Background. Endoscopic therapy is the first-line treatment of choice for control of acute variceal bleeding (AVB). In high-risk patients with persistent AVB despite pharmacological treatment and endoscopic intervention, percutaneous transjugular intrahepatic portosystemic shunting (TIPS) provides a minimally invasive salvage method to reduce portal pressure and control bleeding.
Objectives. To evaluate factors influencing in-hospital mortality after salvage TIPS (sTIPS) in patients with exsanguinating variceal bleeding despite medical treatment and endoscopic intervention.
Methods. Clinical and laboratory data were analysed in all patients treated with sTIPS following failed endoscopic therapy for AVB between August 1991 and November 2020. Factors associated with and predictors of death were determined using bivariate analysis and univariate logistic regression analysis.
Results. Thirty-four patients (29 men, 5 women), mean age 52 years (range 31 - 80), received sTIPS for uncontrolled (n=11) or refractory (n=23) AVB. The causes of portal hypertension were alcohol-related (n=24) and non-alcohol-related cirrhosis. Salvage TIPS controlled bleeding in 32 patients, with recurrence in 1. Ten patients died in hospital (mean 4.8 days, range 1 - 10) of liver failure (n=4), multiorgan failure (n=3), alcoholic cardiomyopathy (n=2) and uncontrolled gastric variceal bleeding (n=1). On bivariate analysis, factors associated with death were Child-Pugh (C-P) score ≥10 (p=0.006), sodium Model for End-stage Liver Disease (MELD-Na) score ≥22 (p<0.001), ≥8 units of blood transfused (p<0.001), Sengstaken-Blakemore balloon tube placement (p<0.001), endotracheal intubation (p<0.001), inotropic support (p<0.001) and endoscopically uncontrolled bleeding (p<0.001). Univariate logistic regression analysis showed that the most significant predictors of mortality were inotrope dependency (odds ratio (OR) 134; p<0.001), endotracheal intubation (OR 99; p<0.001), endoscopically uncontrolled bleeding (OR 28; p=0.001), grade 3 ascites (OR 20.9; p=0.012) and C-P grade C (OR 8.8; p=0.011).
Conclusion. Salvage TIPS controlled variceal bleeding in 94% of patients after failed endoscopic therapy with 29% in-hospital mortality. The most significant predictors of mortality were C-P grade C, grade 3 ascites, inotrope requirement, endotracheal intubation and endoscopically uncontrolled bleeding.
|
| format | Article |
| id | doaj-art-46be3e4825c841c7b9c77f128bab3427 |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-46be3e4825c841c7b9c77f128bab34272025-02-10T12:26:30ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352023-12-01114110.7196/SAMJ.2024.v114i1.1839Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic interventionJ E J Krige0E G Jonas1M Setshedi2S J Beningfield3U K Lotze4M M Bernon5S Burmeister6J C Kloppers7Department of Surgery, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology, Hepatopancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South Africa Department of Surgery, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology, Hepatopancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South AfricaDepartment of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Radiology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology, Hepatopancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology, Hepatopancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology, Hepatopancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology, Hepatopancreatico-Biliary Unit, Groote Schuur Hospital, Cape Town, South Africa Background. Endoscopic therapy is the first-line treatment of choice for control of acute variceal bleeding (AVB). In high-risk patients with persistent AVB despite pharmacological treatment and endoscopic intervention, percutaneous transjugular intrahepatic portosystemic shunting (TIPS) provides a minimally invasive salvage method to reduce portal pressure and control bleeding. Objectives. To evaluate factors influencing in-hospital mortality after salvage TIPS (sTIPS) in patients with exsanguinating variceal bleeding despite medical treatment and endoscopic intervention. Methods. Clinical and laboratory data were analysed in all patients treated with sTIPS following failed endoscopic therapy for AVB between August 1991 and November 2020. Factors associated with and predictors of death were determined using bivariate analysis and univariate logistic regression analysis. Results. Thirty-four patients (29 men, 5 women), mean age 52 years (range 31 - 80), received sTIPS for uncontrolled (n=11) or refractory (n=23) AVB. The causes of portal hypertension were alcohol-related (n=24) and non-alcohol-related cirrhosis. Salvage TIPS controlled bleeding in 32 patients, with recurrence in 1. Ten patients died in hospital (mean 4.8 days, range 1 - 10) of liver failure (n=4), multiorgan failure (n=3), alcoholic cardiomyopathy (n=2) and uncontrolled gastric variceal bleeding (n=1). On bivariate analysis, factors associated with death were Child-Pugh (C-P) score ≥10 (p=0.006), sodium Model for End-stage Liver Disease (MELD-Na) score ≥22 (p<0.001), ≥8 units of blood transfused (p<0.001), Sengstaken-Blakemore balloon tube placement (p<0.001), endotracheal intubation (p<0.001), inotropic support (p<0.001) and endoscopically uncontrolled bleeding (p<0.001). Univariate logistic regression analysis showed that the most significant predictors of mortality were inotrope dependency (odds ratio (OR) 134; p<0.001), endotracheal intubation (OR 99; p<0.001), endoscopically uncontrolled bleeding (OR 28; p=0.001), grade 3 ascites (OR 20.9; p=0.012) and C-P grade C (OR 8.8; p=0.011). Conclusion. Salvage TIPS controlled variceal bleeding in 94% of patients after failed endoscopic therapy with 29% in-hospital mortality. The most significant predictors of mortality were C-P grade C, grade 3 ascites, inotrope requirement, endotracheal intubation and endoscopically uncontrolled bleeding. https://samajournals.co.za/index.php/samj/article/view/1839in-hospital mortalityrecalcitrant variceal bleeding |
| spellingShingle | J E J Krige E G Jonas M Setshedi S J Beningfield U K Lotze M M Bernon S Burmeister J C Kloppers Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention South African Medical Journal in-hospital mortality recalcitrant variceal bleeding |
| title | Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention |
| title_full | Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention |
| title_fullStr | Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention |
| title_full_unstemmed | Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention |
| title_short | Factors influencing in-hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention |
| title_sort | factors influencing in hospital mortality for salvage percutaneous transjugular intrahepatic portosystemic shunting in cirrhotic patients with recalcitrant variceal bleeding after failed endoscopic intervention |
| topic | in-hospital mortality recalcitrant variceal bleeding |
| url | https://samajournals.co.za/index.php/samj/article/view/1839 |
| work_keys_str_mv | AT jejkrige factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention AT egjonas factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention AT msetshedi factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention AT sjbeningfield factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention AT uklotze factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention AT mmbernon factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention AT sburmeister factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention AT jckloppers factorsinfluencinginhospitalmortalityforsalvagepercutaneoustransjugularintrahepaticportosystemicshuntingincirrhoticpatientswithrecalcitrantvaricealbleedingafterfailedendoscopicintervention |