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CN 22-1108/R
Volume 40 Issue 7
Jul.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(7): 1375-1381

Influencing factors for rebleeding and 5-year survival rate after treatment in patients with liver cirrhosis and spontaneous splenorenal shunt

DOI: 10.12449/JCH240715
  • 1.

    Department of Gastroenterology，Xiamen Branch，Zhongshan Hospital，Fudan University，Xiamen，Fujian 361000，China

  • 2.

    Department of Gastroenterology，Zhongshan Hospital，Fudan University，Shanghai 200032，China

Research funding:

National Natural Science Foundation of China (82370622);

Key Project of Natural Science Foundation of Fujian Province (2021D033);

Medical Innovation Project of Fujian Province (2022CXB020);

Guiding Project of Medical and Health Care of Xiamen City (3502Z20209046)

More Information
  • Corresponding author: ZHENG Linlin， azll159@163.com （ORCID： 0000-0003-1660-9163）
  • Received Date: 2023-11-26
  • Accepted Date: 2023-12-26
  • Published Date: 2024-07-25
    Abstract
  •   Objective  To investigate the influencing factors for rebleeding and 5-year survival rate after treatment in patients with liver cirrhosis and spontaneous splenorenal shunt （SSRS）， and to provide a basis for clinical prognostic assessment.  Methods  A total of 95 patients with liver cirrhosis and SSRS who were admitted to Zhongshan Hospital and Xiamen Branch of Fudan University from June 2014 to June 2018 were enrolled， and all patients were followed up for at least 5 years. According to the presence or absence of gastrointestinal bleeding during follow-up， the patients were divided into rebleeding group with 27 patients and non-rebleeding group with 68 patients. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. Univariate and multivariate Cox regression analyses were used to investigate the influencing factors for the prognosis of patients with SSRS， and the Kaplan-Meier method was used to describe survival outcomes. A Pearson or Spearman correlation analysis was performed.  Results  Compared with the non-rebleeding group， the rebleeding group had significantly higher splenorenal shunt diameter ［4.60（3.20 ‍—‍ 5.90） mm vs 3.45（2.10 ‍—‍ 5.45） mm， Z=1.973， P=0.048］ and hepatic venous pressure gradient（18.57±6.60 mmHg vs 15.06±5.82 mmHg， t=2.280， P=0.026） and a significantly lower portal vein diameter（14.04±2.90 mm vs 15.45±2.90 mm， t=2.138， P=0.035）. The correlation analysis showed that splenorenal shunt diameter was negatively correlated with portal vein diameter（rs =-0.211， P=0.040）. Adverse events within 5 years after treatment included rebleeding（27.4%）， portal vein thrombosis（11.6%）， infection（4.2%）， cerebral hemorrhage（1.1%）， and cerebral infarction（1.1%）. Splenorenal shunt diameter（risk ratio ［RR］=1.173， 95% confidence interval ［CI］： 1.001‍ ‍—‍ ‍1.374， P=0.048） and superior mesenteric vein diameter（RR=0.844， 95%CI： 0.746 ‍—‍ 0.956， P=0.007） were independent influencing factors for gastrointestinal rebleeding within 5 years after treatment. Bilirubin（RR=1.028， 95%CI： 1.010 ‍—‍ 1.046， P=0.002） and blood urea nitrogen（RR=1.347， 95%CI： 1.116 ‍—‍ 1.625， P=0.002） were independent risk factors for 5-year survival rate after treatment.  Conclusion  Splenorenal shunt diameter is closely associated with the prognosis of cirrhotic patients， and it is recommended to enhance imaging follow-up of splenorenal shunt diameter for cirrhotic patients with SSRS.

     

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    • References(30)
  • [1]
    TURCO L, GARCIA-TSAO G. Portal hypertension: Pathogenesis and diagnosis[J]. Clin Liver Dis, 2019, 23( 4): 573- 587. DOI: 10.1016/j.cld.2019.07.007.
    [2]
    JOTHIMANI D, RELA M, KAMATH PS. Liver cirrhosis and portal hypertension: How to deal with esophageal varices?[J]. Med Clin North Am, 2023, 107( 3): 491- 504. DOI: 10.1016/j.mcna.2023.01.002.
    [3]
    HEARNSHAW SA, LOGAN RFA, LOWE D, et al. Acute upper gastrointestinal bleeding in the UK: Patient characteristics, diagnoses and outcomes in the 2007 UK audit[J]. Gut, 2011, 60( 10): 1327- 1335. DOI: 10.1136/gut.2010.228437.
    [4]
    SIMÓN-TALERO M, ROCCARINA D, MARTÍNEZ J, et al. Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis[J]. Gastroenterology, 2018, 154( 6): 1694- 1705. DOI: 10.1053/j.gastro.2018.01.028.
    [5]
    LIU GF, WANG XZ, LUO XF. Splenic arteriovenous fistula coexisting with spontaneous splenorenal shunt in a cirrhotic patient[J]. Clin Gastroenterol Hepatol, 2023, 21( 10): A33. DOI: 10.1016/j.cgh.2023.03.007.
    [6]
    YI FF, GUO XZ, WANG L, et al. Impact of spontaneous splenorenal shunt on liver volume and long-term survival of liver cirrhosis[J]. J Gastroenterol Hepatol, 2021, 36( 6): 1694- 1702. DOI: 10.1111/jgh.15386.
    [7]
    DING HG, XU XY, LINGHU EQ, et al. Interpretation of guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32( 2): 220- 222. DOI: 10.3969/j.issn.1001-5256.2016.02.003.

    丁惠国, 徐小元, 令狐恩强, 等.《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》解读[J]. 临床肝胆病杂志, 2016, 32( 2): 220- 222. DOI: 10.3969/j.issn.1001-5256.2016.02.003.
    [8]
    GARCIA-TSAO G. Can we rely on changes in HVPG in patients with cirrhosis?[J]. Hepatology, 2021, 74( 6): 2945- 2947. DOI: 10.1002/hep.32159.
    [9]
    Chinese Society of Hepatology, Chinese Society of Gastroenterology, and Chinese Society of Digestive Endoscopology of Chinese Medical Association. Guidelines on the management of esophagogastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2023, 39( 3): 527- 538.

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志, 2023, 39( 3): 527- 538.
    [10]
    WANG Q, ZHAO H, DENG Y, et al. Validation of Baveno VII criteria for recompensation in entecavir-treated patients with hepatitis B-related decompensated cirrhosis[J]. J Hepatol, 2022, 77( 6): 1564- 1572. DOI: 10.1016/j.jhep.2022.07.037.
    [11]
    ACHIWA S, HIROTA S, KAKO Y, et al. Radiological anatomy of spontaneous splenorenal shunts in patients with chronic liver disease[J]. Jpn J Radiol, 2017, 35( 4): 206- 214. DOI: 10.1007/s11604-017-0623-1.
    [12]
    PAN WD, XU RY, ZHENG FP, et al. Relationship between portal hypertensive gastropathy and existence of spontaneous spenorenal shunts[J]. China J Endosc, 2005, 11( 5): 481- 483. DOI: 10.3969/j.issn.1007-1989.2005.05.013.

    潘卫东, 许瑞云, 郑丰平, 等. 自发性脾肾分流对门静脉高压性胃病的影响[J]. 中国内镜杂志, 2005, 11( 5): 481- 483. DOI: 10.3969/j.issn.1007-1989.2005.05.013.
    [13]
    GAO X, LIU YB, XIAO Y, et al. Clinical features and management of varices with splenorenal or gastrorenal shunt[J]. Chin J Dig Endosc, 2022, 39( 5): 352- 357. DOI: 10.3760/cma.j.cn321463-20210824-00533.

    高欣, 刘苑斌, 肖勇, 等. 脾肾或胃肾分流型静脉曲张的临床特征与处置[J]. 中华消化内镜杂志, 2022, 39( 5): 352- 357. DOI: 10.3760/cma.j.cn321463-20210824-00533.
    [14]
    BRAUN MM, BAR-NATHAN N, SHAHARABANI E, et al. Postshunt hepatic encephalopathy in liver transplant recipients[J]. Transplantation, 2009, 87( 5): 734- 739. DOI: 10.1097/TP.0b013e318196340d.
    [15]
    MARETTI-MIRA AC, WANG XD, WANG L, et al. Incomplete differentiation of engrafted bone marrow endothelial progenitor cells initiates hepatic fibrosis in the rat[J]. Hepatology, 2019, 69( 3): 1259- 1272. DOI: 10.1002/hep.30227.
    [16]
    BERZIGOTTI A, MERKEL C, MAGALOTTI D, et al. New abdominal collaterals at ultrasound: A clue of progression of portal hypertension[J]. Dig Liver Dis, 2008, 40( 1): 62- 67. DOI: 10.1016/j.dld.2007.08.011.
    [17]
    FRANZONI LD, de CARVALHO FC, GARZON RG, et al. Embolization of splenorenal shunt associated to portal vein thrombosis and hepatic encephalopathy[J]. World J Gastroenterol, 2014, 20( 42): 15910- 15915. DOI: 10.3748/wjg.v20.i42.15910.
    [18]
    KOK B, ABRALDES JG. Child-pugh classification: Time to abandon?[J]. Semin Liver Dis, 2019, 39( 1): 96- 103. DOI: 10.1055/s-0038-1676805.
    [19]
    KE Q, WANG ZY, HUANG XH, et al. Splenic vein embolization as a feasible treatment for patients with hepatic encephalopathy related to large spontaneous splenorenal shunts[J]. Ann Hepatol, 2022, 27( 5): 100725. DOI: 10.1016/j.aohep.2022.100725.
    [20]
    CHIKAMORI F, OKAMOTO H, KUNIYOSHI N. Relationships between splenorenal shunt/portal vein diameter ratio and systemic hemodynamics in patients with liver cirrhosis[J]. Digestion, 2014, 89( 2): 133- 138. DOI: 10.1159/000357494.
    [21]
    WANG QH, LV Y, BAI M, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67( 3): 508- 516. DOI: 10.1016/j.jhep.2017.05.006.
    [22]
    GUILLAUME M, BUREAU C. Should the presence of spontaneous portosystemic shunts be implemented to the model for end-stage liver disease score for a better prediction of outcome?[J]. Gastroenterology, 2018, 154( 6): 1569- 1571. DOI: 10.1053/j.gastro.2018.03.035.
    [23]
    CHEN J, QIAN JQ, WANG GH, et al. A new non-invasive liver disease model to judge the prognosis of patients with acute upper gastrointestinal hemorrhage due to cirrhosis[J]. J Chin Physician, 2020, 22( 1): 54- 58. DOI: 10.3760/cma.j.issn.1008-1372.2020.01.014.

    陈健, 钱建清, 王甘红, 等. 全新无创肝病模型判断肝硬化急性上消化道出血患者的预后[J]. 中国医师杂志, 2020, 22( 1): 54- 58. DOI: 10.3760/cma.j.issn.1008-1372.2020.01.014.
    [24]
    LIU HQ, NGUYEN HH, HWANG SY, et al. Oxidative mechanisms and cardiovascular abnormalities of cirrhosis and portal hypertension[J]. Int J Mol Sci, 2023, 24( 23): 16805. DOI: 10.3390/ijms242316805.
    [25]
    DAI C, LIU WX, JIANG M, et al. Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage: A meta-analysis[J]. World J Gastroenterol, 2015, 21( 8): 2534- 2541. DOI: 10.3748/wjg.v21.i8.2534.
    [26]
    WU Q, JIANG H, LINGHU EQ, et al. BRTO assisted endoscopic Histoacryl injection in treating gastric varices with gastrorenal shunt[J]. Minim Invasive Ther Allied Technol, 2016, 25( 6): 337- 344. DOI: 10.1080/13645706.2016.1192552.
    [27]
    KHAN S, TUDUR SMITH C, WILLIAMSON P, et al. Portosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis[J]. Cochrane Database Syst Rev, 2006, 2006( 4): CD000553. DOI: 10.1002/14651858.CD000553.pub2.
    [28]
    KISAOGLU A, DANDIN O, DEMIRYILMAZ I, et al. A single-center experience in portal flow augmentation in liver transplantation with prior large spontaneous splenorenal shunt[J]. Transplant Proc, 2021, 53( 1): 54- 64. DOI: 10.1016/j.transproceed.2020.05.015.
    [29]
    NICKKHOLGH A, WANG JZ, SHAHBAZOV R, et al. Intervention on spontaneous splenorenal shunt may decrease the incidence of acute kidney injury after liver transplant[J]. Exp Clin Transplant, 2020, 18( 3): 320- 324. DOI: 10.6002/ect.2019.0248.
    [30]
    SAKS K, JENSEN KK, MCLOUTH J, et al. Influence of spontaneous splenorenal shunts on clinical outcomes in decompensated cirrhosis and after liver transplantation[J]. Hepatol Commun, 2018, 2( 4): 437- 444. DOI: 10.1002/hep4.1157.
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