Risk of portal hypertensive complications preventable by TIPS in patients with ascites

作者：Lorenz Balcar, Marta Tonon, Joan Valls, Valeria Calvino, Lucie Simonis, Jan Embacher, Roberta Gagliardi, Christian Sebesta, Leonie Hafner, Antonio Accetta, Lukas Hartl, Mattias Mandorfer, Michael Trauner, Paolo Angeli, Thomas Reiberger, Juan Carlos García‐Pagán, Georg Semmler, Salvatore Piano · 发表于：JHEP Reports · 年份：2025 · DOI：10.1016/j.jhepr.2025.101469 · 被引用次数：4 · 研究领域：Liver Disease and Transplantation、Clinical Nutrition and Gastroenterology、Liver Diseases and Immunity

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of recurrent/refractory ascites in patients with cirrhosis. The aim of this study is to identify patients with ascites as index decompensation who are at risk of developing portal hypertension (PH)-related complications within 12 months that seem preventable by TIPS. Methods: We included 451 patients from two tertiary care centres (Vienna and Padua, derivation cohort) with clinically significant ascites (grade 2/3) as a single first decompensating event and without contraindications for TIPS placement. Multivariable logistic regression analysis was used to identify variables independently associated with a composite endpoint of PH-related complications (encephalopathy excluded), liver transplantation, or liver-related death. A classification tree was used to identify patients at highest risk for these PH-related complications. Risk estimates were validated in a temporal validation cohort from Vienna (n = 84). Results: In the derivation cohort (mean age 56 ± 11 years; 69% male; 51% alcohol-related cirrhosis; 44% ascites grade 3; median model for end-stage liver disease [MELD] 12 points), 152 (34%) patients developed the composite endpoint within 12 months. A model including ascites grade, sodium, and MELD accurately predicted the occurrence of this composite endpoint (area under the receiver operator characteristics curve: 0.79 [95% CI: 0.75-0.84]). Two high-risk clusters were ide...