Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study
Objectives The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus extrahepatic collateral embolisation (TIPS+E) in reducing rebleeding and hepatic encephalopathy (HE) post-TIPS was recently reported in a meta-analysis, but further validation is essential. This study aims to confir...
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BMJ Publishing Group
2024-05-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/11/1/e001310.full |
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| author | Chao Chen Feng Zhang Hao Wu Wei Wu Hui Xue Yuzheng Zhuge Chunqing Zhang Guangchuan Wang Zhengjie Li Qiong Wu Bo Wei Jun Tie Xiubin Sun Lianhui Zhao Yifu Xia Jiao Xu Peijie Li |
| author_facet | Chao Chen Feng Zhang Hao Wu Wei Wu Hui Xue Yuzheng Zhuge Chunqing Zhang Guangchuan Wang Zhengjie Li Qiong Wu Bo Wei Jun Tie Xiubin Sun Lianhui Zhao Yifu Xia Jiao Xu Peijie Li |
| author_sort | Chao Chen |
| collection | DOAJ |
| description | Objectives The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus extrahepatic collateral embolisation (TIPS+E) in reducing rebleeding and hepatic encephalopathy (HE) post-TIPS was recently reported in a meta-analysis, but further validation is essential. This study aims to confirm the effectiveness of TIPS+E using real-world data.Methods The multicentre retrospective cohort included 2077 patients with cirrhosis who underwent TIPS±E (TIPS: 631, TIPS+E: 1446) between January 2010 and December 2022. Regression and propensity score matching (PSM) were used to adjust for baseline characteristic differences. After PSM, clinical outcomes, including rebleeding, HE, survival and further decompensation (FDC), were analysed. Baseline data from all patients contributed to the construction of prognostic models.Results After PSM, 1136 matched patients (TIPS+E: TIPS=568:568) were included. TIPS+E demonstrated a significant reduction in rebleeding (HR 0.77; 95% CI 0.59 to 0.99; p=0.04), HE (HR 0.82; 95% CI 0.68 to 0.99; p=0.04) and FDC (HR 0.85; 95% CI 0.73 to 0.99; p=0.04), comparing to TIPS. Significantly, TIPS+E also reduced rebleeding, HE and FDC in subgroup of using 8 mm diameter stents and embolising of gastric varices+spontaneous portosystemic shunts (GV+SPSS). However, there were no differences in overall or subgroup survival analysis. Additionally, the random forest models showed higher accuracy and AUROC comparing to other models. Controlling post-TIPS portal pressure gradient (pPPG) within 7 mm Hg<pPPG<8.5 mm Hg improved prognosis, especially in TIPS+E group.Conclusion Our real-world data validation confirms the high efficacy of TIPS+E in reducing rebleeding and HE, particularly when using 8 mm diameter stents, embolising GV+SPSS and maintaining an optimal pPPG. |
| format | Article |
| id | doaj-art-d40daf8cb194417181d62fd8deea6d0b |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-d40daf8cb194417181d62fd8deea6d0b2025-02-12T07:30:11ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742024-05-0111110.1136/bmjgast-2023-001310Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation studyChao Chen0Feng Zhang1Hao Wu2Wei Wu3Hui Xue4Yuzheng Zhuge5Chunqing Zhang6Guangchuan Wang7Zhengjie Li8Qiong Wu9Bo Wei10Jun Tie11Xiubin Sun12Lianhui Zhao13Yifu Xia14Jiao Xu15Peijie Li16Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People`s Republic of ChinaGuangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People`s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, ChinaDepartment of Gastroenterology, Central South University Third Xiangya Hospital, Changsha, ChinaEye Center of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China3Leeds Teaching Hospitals NHS TrustGastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsun Province, People`s Republic of ChinaGastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, People`s Republic of ChinaDepartment of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province, People`s Republic of ChinaSchool of Automation, Qingdao University, Qingdao, Shandong Province, People`s Republic of ChinaGastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, People`s Republic of ChinaGastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People`s Republic of ChinaDepartment of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, Shaanxi, People`s Republic of ChinaDepartment of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province, People`s Republic of ChinaGastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, People`s Republic of ChinaGastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, People`s Republic of ChinaDepartment of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, Shaanxi, People`s Republic of ChinaGastroenterology, First Affiliated Hospital of Xi`an Jiaotong University, Xi`an, Shaanxi Province, ChinaObjectives The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus extrahepatic collateral embolisation (TIPS+E) in reducing rebleeding and hepatic encephalopathy (HE) post-TIPS was recently reported in a meta-analysis, but further validation is essential. This study aims to confirm the effectiveness of TIPS+E using real-world data.Methods The multicentre retrospective cohort included 2077 patients with cirrhosis who underwent TIPS±E (TIPS: 631, TIPS+E: 1446) between January 2010 and December 2022. Regression and propensity score matching (PSM) were used to adjust for baseline characteristic differences. After PSM, clinical outcomes, including rebleeding, HE, survival and further decompensation (FDC), were analysed. Baseline data from all patients contributed to the construction of prognostic models.Results After PSM, 1136 matched patients (TIPS+E: TIPS=568:568) were included. TIPS+E demonstrated a significant reduction in rebleeding (HR 0.77; 95% CI 0.59 to 0.99; p=0.04), HE (HR 0.82; 95% CI 0.68 to 0.99; p=0.04) and FDC (HR 0.85; 95% CI 0.73 to 0.99; p=0.04), comparing to TIPS. Significantly, TIPS+E also reduced rebleeding, HE and FDC in subgroup of using 8 mm diameter stents and embolising of gastric varices+spontaneous portosystemic shunts (GV+SPSS). However, there were no differences in overall or subgroup survival analysis. Additionally, the random forest models showed higher accuracy and AUROC comparing to other models. Controlling post-TIPS portal pressure gradient (pPPG) within 7 mm Hg<pPPG<8.5 mm Hg improved prognosis, especially in TIPS+E group.Conclusion Our real-world data validation confirms the high efficacy of TIPS+E in reducing rebleeding and HE, particularly when using 8 mm diameter stents, embolising GV+SPSS and maintaining an optimal pPPG.https://bmjopengastro.bmj.com/content/11/1/e001310.full |
| spellingShingle | Chao Chen Feng Zhang Hao Wu Wei Wu Hui Xue Yuzheng Zhuge Chunqing Zhang Guangchuan Wang Zhengjie Li Qiong Wu Bo Wei Jun Tie Xiubin Sun Lianhui Zhao Yifu Xia Jiao Xu Peijie Li Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study BMJ Open Gastroenterology |
| title | Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study |
| title_full | Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study |
| title_fullStr | Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study |
| title_full_unstemmed | Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study |
| title_short | Efficacy of TIPS plus extrahepatic collateral embolisation in real-world data: a validation study |
| title_sort | efficacy of tips plus extrahepatic collateral embolisation in real world data a validation study |
| url | https://bmjopengastro.bmj.com/content/11/1/e001310.full |
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