The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study

作者：Shoma Bommena, Nadim Mahmud, Justin Boike, Bartley Thornburg, K. Kolli, Jennifer C. Lai, Margarita N. German, Giuseppe Morelli, Erin Spengler, Adnan Said, Archita P. Desai, Shilpa Junna, Sonali Paul, Catherine Frenette, Elizabeth C. Verna, Aparna Goel, Dyanna L. Gregory, Cynthia Padilla, Lisa B. VanWagner, Michael B. Fallon, on behalf of Advancing Liver Therapeutic Approaches (ALTA) Study Group · 发表于：Hepatology · 年份：2023 · DOI：10.1097/hep.0000000000000283 · 被引用次数：20 · 研究领域：Pulmonary Hypertension Research and Treatments、Liver Disease and Transplantation、Cardiovascular Function and Risk Factors

BACKGROUND AND AIMS: Single-center studies in patients undergoing TIPS suggest that elevated right atrial pressure (RAP) may influence survival. We assessed the impact of pre-TIPS RAP on outcomes using the Advancing Liver Therapeutic Approaches (ALTA) database. APPROACH AND RESULTS: Total 883 patients in ALTA multicenter TIPS database from 2010 to 2015 from 9 centers with measured pre-TIPS RAP were included. Primary outcome was mortality. Secondary outcomes were 48-hour post-TIPS complications, post-TIPS portal hypertension complications, and post-TIPS inpatient admission for heart failure. Adjusted Cox Proportional hazards and competing risk model with liver transplant as a competing risk were used to assess RAP association with mortality. Restricted cubic splines were used to model nonlinear relationship. Logistic regression was used to assess RAP association with secondary outcomes.Pre-TIPS RAP was independently associated with overall mortality (subdistribution HR: 1.04 per mm Hg, 95% CI, 1.01, 1.08, p =0.009) and composite 48-hour complications. RAP was a predictor of TIPS dysfunction with increased odds of post-90-day paracentesis in outpatient TIPS, hospital admissions for renal dysfunction, and heart failure. Pre-TIPS RAP was positively associated with model for end-stage liver disease, body mass index, Native American and Black race, and lower platelets. CONCLUSIONS: Pre-TIPS RAP is an independent risk factor for overall mortality after TIPS insertion. Higher pre-TIP...