Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis

Background & Aims: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. Thi...

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Detalles Bibliográficos
Autores: Praktiknjo, Michael, Simón-Talero, Macarena, Römer, Julia, Roccarina, Davide, Martínez, Javier, Lampichler, Katharina, Baiges, Anna, Low, Gavin, Llop, Elba, Maurer, Martin H., Zipprich, Alexander, Triolo, Michela, Maleux, Geert, Fialla, Annette Dam, Dam, Claus, Vidal-González, Judit, Majumdar, Avik, Picón, Carmen, Toth, Daniel, Darnell, Anna, Abraldes, Juan G., López, Marta, Jansen, Christian, Chang, Johannes, Schierwagen, Robert, Uschner, Frank, Kukuk, Guido, Meyer, Carsten, Thomas, Daniel, Wolter, Karsten, Strassburg, Christian P., Laleman, Wim, La Mura, Vincenzo, Ripoll, Cristina, Berzigotti, Annalisa, Calleja Panero, José Luis, Tandon, Puneeta, Hernandez-Gea, Virginia, Reiberger, Thomas, Albillos, Agustín, Tsochatzis, Emmanuel A., Krag, Aleksander, Genescà, Joan, Trebicka, Jonel, Quiroga, Sergi, Yu, Dominic, Téllez, Luis, Mandorfer, Mattias, Garcia-Pagan, Juan Carlos, Berbel, Claudia, Ferrusquia, José, Ble, Michel, Garcia-Criado, Mari Angeles, Belmonte, Ernest, Ney, Michael, Margini, Cristina, Casu, Stefania, Murgia, Giuseppe, Ludwig, Christiane, Stangl, Franz
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Universidad Autónoma de Madrid
Repositorio:Biblos-e Archivo. Repositorio Institucional de la UAM
Idioma:inglés
OAI Identifier:oai:repositorio.uam.es:10486/694244
Acceso en línea:http://hdl.handle.net/10486/694244
https://dx.doi.org/10.1016/j.jhep.2019.12.021
Access Level:acceso abierto
Palabra clave:ACLF
Acute decompensation
Acute-on-chronic liver failure
Ascites
Cirrhosis
Computed tomography
Hepatic encephalopathy
Portal hypertension
Spontaneous portosystemic shunt
SPSS
TIPS
Liveren_US
Medicina
Descripción
Sumario:Background & Aims: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis. Methods: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint. Results: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02–2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA. Conclusion: This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis. Lay summary: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.

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