Factors related to early mortality after transjugular intrahepatic portosystemic shunt for failed endoscopic therapy in acute variceal bleeding

Patch, David; Nikolopoulou, V.; McCormick, Aiden; Dick, Robert; Armonis, Anastasios; Wannamethee, S. Goya; Burroughs, Andrew K.

doi:10.1016/s0168-8278(98)80320-6

Cited by 115 publications

(60 citation statements)

References 16 publications

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“…Survival rates are similar when the indication is ascites (48%-76%). [25][26][27][28][29][30] In one series but not another, survival rates were significantly worse when the indication was refractory ascites compared with variceal bleeding. 26,29 These differences likely reflect variations in the severity of liver disease between the different studies.…”

Section: Mortalitymentioning

confidence: 87%

“…MELD and a number of other models have been developed to predict survival following TIPS. [25][26][27][28][29] The modified MELD model utilizes serum bilirubin level, international normalized ratio for prothrombin time, and serum creatinine level (cause of cirrhosis was also used previously but has since been abandoned). These three variables are used to create the following equation: [3.8 log e (bilirubin [g/dL]) ϩ 11.2 log e (international normalized ratio) ϩ 9.6 log e (creatinine [mg/dL].…”

Section: Mortalitymentioning

confidence: 99%

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The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

2005

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Section: Mortalitymentioning

confidence: 87%

Section: Mortalitymentioning

confidence: 99%

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

2005

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“…Predictors of mortality were evaluated prospectively by Patch et al [29], who considered that six factors were independent prognostic risk for death: moderate to severe ascites, need for ventilation, white blood cell count, platelet count, partial thromboplastin time, and creatinine. In a recent study, an initial WBC over 10.3 × 10 9 /l is independently associated with failure and mortality at 5 days [30].…”

Section: Discussionmentioning

confidence: 99%

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

Hunaysh¹

2016

OJGas

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Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana'a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endo-scope (P < 0.0001), high serum bilirubin (P = 0.02), CTP score (P < 0.05) and MELD score (P < 0.05). Independent risks factors remained in multivariate analysis as significant predictors of early rebleeding were clot on varix (OR: 11.6, CI: 2.87 -47.29, P = 0.001) and high serum bilirubin (>3) (OR: 1.1, CI: 1.02 -1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P < 0.0001), low serum sodium (P = 0.04), high AST (P < 0.0001), high ALT (P = 0.02), high INR (P < 0.0001), high serum bilirubin (P < 0.0001), low serum albumin (P = 0.005), ascites (P = 0.001), A. Y. Hunaysh 215 CTP score (P < 0.0001) and MELD score (P < 0.0001). By multiple regression analysis high MELD score (≥19) (OR: 1.3, CI: 1.12 -1.41, P < 0.0001) and WBCs over 10.3 × 10 9 /l (OR: 1.2, CI: 1.02 -1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 10 9 /l.

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“…It is well recognized that the need for an emergency TIPS, that is, TIPS being performed for the control of acute variceal hemorrhage, is associated with a high mortality. 5,6 Some factors predictive of poor survival after elective TIPS, such as advanced liver disease 3,4,7,8 and hyperbilirubinemia, 9 have been recognized. However, there has been no model developed that can accurately predict survival after elective TIPS.…”

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confidence: 99%

A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts

et al. 2000

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Factors related to early mortality after transjugular intrahepatic portosystemic shunt for failed endoscopic therapy in acute variceal bleeding

Cited by 115 publications

References 16 publications

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension

Prediction of Early Rebleeding and Mortality after Acute Esophageal Variceal Hemorrhage among Yemeni Patients in Major Hospitals—Sana’a

A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts

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