Safety and efficacy of transjugular intrahepatic portosystemic shunt in treatment of acute decompensated cirrhotic events in patients with acute-on-chronic liver failure

Objective To investigate the safety and efficacy of transjugular intrahepatic portosystemic shunt( TIPS) in the treatment of acute decompensated cirrhotic events in patients with acute-on-chronic liver failure( ACLF). Methods A retrospective analysis was performed for the clinical data of 35 patients with ACLF and acute decompensated cirrhotic events who were hospitalized and underwent TIPS in Xijing Hospital of Digestive Diseases,Air Force Medical University,from June 2008 to December 2017,and 35 patients,matched by the propensity score at a ratio of 1∶ 1,who underwent medical treatment were enrolled. Related clinical,laboratory,and imaging data were collected. The t-test or the Mann-Whitney U test was used for comparison of continuous variables between two groups,and the chi-square test used for comparison of categorical data. A logistic regression model was used to investigate the risk factors for disease progression; the Kaplan-Meier method was used to estimate cumulative survival probability; the Cox regression model was used to determine the risk factors for survival,and a competing-risk model was used to compare the incidence rate of hepatic encephalopathy during follow-up. Results Among the patients who underwent TIPS,20 achieved disease improvement and 15 had stable conditions or experienced aggravation,while among the patients who received medical treatment,11 achieved disease improvement and 24 had stable conditions or experienced aggravation; the TIPS group had a significantly higher proportion of patients with improvement than the medical treatment group( χ2= 4. 69,P =0. 03). After the adjustment for sex and age in the logistic regression model,TIPS was more helpful for disease improvement than medical treatment( odds ratio = 3. 02,95% confidence interval [CI]: 0. 12-0. 91,P = 0. 03). The 28-and 180-day mortality rates were22. 9% and 42. 9%,respectively,in the TIPS group and 17. 1% and 68. 6%,respectively,in the medical treatment group,and the TIPS group had a significantly higher 180-day survival rate than the medical treatment group( χ2= 3. 92,P = 0. 048). The Cox multivariate analysis showed that serum total bilirubin was an independent risk factor for prognosis( hazard ratio = 1. 04,95% CI: 1. 01-1. 07,P =0. 006). There was no significant difference in the incidence rate of hepatic encephalopathy during follow-up between the TIPS group and the medical treatment group( 25. 7% vs 20. 0%,χ2= 0. 43,P = 0. 51). Conclusion Compared with medical treatment,TIPS is a safe and effective method for acute decompensated cirrhotic events in patients with ACLF and can significantly improve disease progression and survival,and meanwhile,it does not increase the incidence rate of hepatic encephalopathy.