Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patients with intractable cirrhotic ascites and prognostic factors / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the long-term therapeutic effect of transjugular intrahepatic portosystemic shunt (TIPS) in patients with intractable cirrhotic ascites and prognostic factors. MethodsA retrospective analysis was performed for the clinical data of 57 patients with intractable cirrhotic ascites who were received TIPS in our hospital from January 2009 to June 2014. Regular telephone follow-up was performed in all patients. Laboratory testing results and abdominal ultrasound and CT findings were examined. The improvement in ascites and survival were evaluated. The χ2 test was applied for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative probability of survival and other cumulative probabilities, the log-rank test was used for survival difference analysis, the Cox regression model was used to analyze prognostic factors, and the receiver operating characteristic curve(ROC) and the area under the curve(AUC) were used to determine the optimal cut-off values of prognostic factors. ResultsThe 1-year ascites remission rate after TIPS was 93%, and the 1- and 2-year survival rates were 60% and 43%, respectively. The multivariate Cox regression analysis showed that Child-Pugh score (HR=268, 95%CI 1.009-1.594, P=0.042) and urea nitrogen (HR=1.143, 95%CI 1034-1.264, P=0.009,) were predictive factors for 1-year survival rate after TIPS in patients with intractable cirrhotic ascites. The area under the ROC curve of Child-Pugh score was 0.699 (P=0011, 95%CI 0.558-0.840), and the optimal cut-off value of Child-Pugh score was 8, with a sensitivity of 75% and a specificity of 67%. The Kaplan-Meier survival analysis demonstrated that the 1-year survival rates of patients with Child-Pugh scores of ≤8 and ＞8 were 82% and 38%, respectively (χ2=10.888, P=0.001). ConclusionTIPS is safe and effective in the treatment of intractable ascites, and Child-Pugh score ≤8 is a predictive factor for 1-year survival rate in such patients.