Long-term outcomes of early transjugular intrahepatic portosystemic shunts in patients with acute variceal bleeding and cirrhosis

Table 1 Patient demographics and clinical characteristics, n (%)

Characteristics	Early TIPS (n = 37)	Standard treatment (n = 65)	P value
Age (year), mean ± SD	64.5 ± 10.3	61.3 ± 10.3	0.138
Sex			0.003
Male	14 (37.8)	44 (67.7)
Female	23 (62.2)	21 (32.3)
Cause of cirrhosis			0.474
HBV	17 (45.9)	29 (44.6)
HCV	3 (8.1)	6 (9.2)
Alcohol	1 (2.7)	8 (12.3)
Autoimmune hepatitis	4 (10.8)	8 (12.3)
Other	12 (32.4)	14 (21.5)
Comorbidities
Hypertension	10 (27.0)	14 (21.5)	0.53
Diabetes	15 (40.5)	17 (26.2)	0.132
Cardiovascular disease	2 (5.4)	3 (4.6)	1
Cerebrovascular disease	3 (8.1)	3 (4.6)	0.777
Ascites	22 (59.5)	33 (50.8)	0.397
Child-Pugh score, median (IQR)	8.0 (8.0-9.0)	8.0 (8.0-9.0)	0.275
Child-Pugh class			0.637
Child-Pugh B	31 (83.8)	52 (80.0)
Child-Pugh C	6 (16.2)	13 (20.0)
MELD score, median (IQR)	6.0 (1.5-8.5)	8.0 (3.0-11.0)	0.027
White blood cell (× 109/L), median (IQR)	4.0 (2.8-8.0)	5.9 (3.1-10.9)	0.127
Hemoglobin (g/L), median (IQR)	81.0 (70.5-101.5)	78.0 (66.0-94.0)	0.364
Platelet count (× 109/L), median (IQR)	76.0 (49.5-105.5)	69.0 (45.5-98.5)	0.335
Albumin (g/L)	28.7 (6.3)	28.1 (6.2)	0.63
Creatinine (mg/dL), median (IQR)	0.7 (0.6-0.9)	0.9 (0.7-1.2)	< 0.001
Bilirubin (mg/dL), median (IQR)	1.2 (0.9-1.9)	1.5 (1.0-2.1)	0.106
International normalized ratio, median (IQR)	1.2 (1.1-1.5)	1.3 (1.2-1.4)	0.215
Initial endoscopic treatment			0.317
Endoscopic band ligation	32 (86.5)	51 (78.5)
Endoscopic sclerotherapy	5 (13.5)	19 (21.5)
Initial vasoactive-drug therapy			0.613
Terlipressin	11 (29.7)	14 (21.5)
Somatostatin	24 (64.9)	48 (73.8)
Octreotide	2 (5.4)	3 (4.6)

TIPS: Transjugular intrahepatic portosystemic shunts; HBV: Hepatitis B virus; HCV: Hepatitis C virus; IQR: Interquartile range; MELD: Model for end-stage liver disease.

Table 2 Outcomes of early transjugular intrahepatic portosystemic shunts and standard treatment, n (%)

Characteristics	Early TIPS (n = 37)	Standard treatment (n = 65)	P value
Failure to control bleeding or rebleeding	4 (10.8)	33 (50.8)	< 0.001
Uncontrolled bleeding	0 (0)	9 (13.8)	0.045
Early rebleeding	0 (0)	3 (4.6)	0.473
Late rebleeding	4 (10.8)	21 (32.3)	0.015
Cause of bleeding1			0.144
Varices	1 (25.0)	23 (69.7)
Portal hypertensive gastropathy	1 (25.0)	4 (12.1)
Gastric ulcer	0 (0)	2 (6.1)
Mallory Weiss	1 (25.0)	2 (6.1)
Gastrointestinal telangiectasia	1 (25.0)	2 (6.1)
Death	7 (18.9)	10 (15.4)	0.645
Cause of death2			0.201
Liver failure	3 (42.9)	3 (30.0)
Multiorgan failure	2 (28.6)	1 (10.0)
Hepatocellular carcinoma	2 (28.6)	0 (0)
Sepsis/pneumonia	0 (0)	3 (30.0)
Gastrointestinal bleeding	0 (0)	2 (20.0)
Unrelated to liver disease	0 (0)	1 (10.0)
Length of stay	9.0 (7.0-13.5)	14.0 (9.0-18.5)	0.001
Length of stay in ICU, median (IQR)	1.0 (1.0-3.0)	1.0 (1.0-3.0)	0.777
Hospitalization times during follow-up, median (IQR)	2.0 (1.0-4.0)	4.0 (2.0-6.0)	0.003

¹The denominator is the total number of patients with failure to control bleeding or rebleeding.

²The denominator is the total number of deaths.

TIPS: Transjugular intrahepatic portosystemic shunts; ICU: Intensive care unit; IQR: Interquartile range.

Table 3 Univariate and multivariate Cox regression analysis for overall survival

Characteristics	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Treatment, early TIPS vs standard treatment	0.72 (0.27-1.92)	0.511	-	-
Age (years)	1.05 (1.00-1.11)	0.049	1.04 (0.98-1.10)	0.22
Sex, male vs female	0.85 (0.33-2.20)	0.734	-	-
Comorbidities, yes vs no	4.73 (1.54-14.56)	0.007	3.81 (1.16-12.46)	0.027
Bilirubin	1.30 (0.84-2.01)	0.237	-	-
Creatinine	2.24 (0.72-7.01)	0.165	-	-
Child-Pugh score	1.56 (1.09-2.21)	0.014	1.40 (0.90-2.15)	0.132
MELD score	1.09 (1.01-1.18)	0.026	1.06 (0.98-1.16)	0.168

HR: Hazard ratio; CI: Confidence interval; TIPS: Transjugular intrahepatic portosystemic shunts; MELD: Model for end-stage liver disease.

Table 4 Adverse events of early transjugular intrahepatic portosystemic shunts and standard treatment, n (%)

Characteristics	Early TIPS (n = 37)	Standard treatment (n = 65)	P value
Complications of portal hypertension
OHE	17 (45.9)	24 (36.9)	0.372
New or worsening ascites	5 (13.5)	25 (38.5)	0.008
Hepatocellular carcinoma	5 (13.5)	6 (9.2)	0.735
Spontaneous bacterial peritonitis	3 (8.1)	6 (9.2)	1
Hepatopulmonary syndrome	0 (0)	1 (1.5)	1
Hepatorenal syndrome	2 (5.4)	0 (0)	0.129
Other serious adverse events
Acute-on-chronic liver failure	4 (10.8)	4 (6.2)	0.647
Portal vein thrombosis	4 (10.8)	4 (6.2)	0.647
Sepsis	2 (5.4)	0 (0)	0.129
Pneumonia	1 (2.7)	1 (1.5)	1

TIPS: Transjugular intrahepatic portosystemic shunts; OHE: Overt hepatic encephalopathy.