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...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| 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 |
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| dc.title.none.fl_str_mv |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| title |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| spellingShingle |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis Praktiknjo, Michael ACLF Acute decompensation Acute-on-chronic liver failure Ascites Cirrhosis Computed tomography Hepatic encephalopathy Portal hypertension Spontaneous portosystemic shunt SPSS TIPS Liveren_US Medicina |
| title_short |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| title_full |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| title_fullStr |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| title_full_unstemmed |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| title_sort |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis |
| dc.creator.none.fl_str_mv |
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 |
| author |
Praktiknjo, Michael |
| author_facet |
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 |
| author_role |
author |
| author2 |
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 |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Departamento de Medicina Facultad de Medicina |
| dc.subject.none.fl_str_mv |
ACLF Acute decompensation Acute-on-chronic liver failure Ascites Cirrhosis Computed tomography Hepatic encephalopathy Portal hypertension Spontaneous portosystemic shunt SPSS TIPS Liveren_US Medicina |
| topic |
ACLF Acute decompensation Acute-on-chronic liver failure Ascites Cirrhosis Computed tomography Hepatic encephalopathy Portal hypertension Spontaneous portosystemic shunt SPSS TIPS Liveren_US Medicina |
| description |
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. |
| publishDate |
2020 |
| dc.date.none.fl_str_mv |
2020 2020-06-01 |
| dc.type.none.fl_str_mv |
research article http://purl.org/coar/resource_type/c_2df8fbb1 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
http://hdl.handle.net/10486/694244 https://dx.doi.org/10.1016/j.jhep.2019.12.021 |
| url |
http://hdl.handle.net/10486/694244 https://dx.doi.org/10.1016/j.jhep.2019.12.021 |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
| dc.rights.none.fl_str_mv |
open access http://purl.org/coar/access_right/c_abf2 |
| dc.rights.openaire.fl_str_mv |
info:eu-repo/semantics/openAccess |
| rights_invalid_str_mv |
open access http://purl.org/coar/access_right/c_abf2 |
| eu_rights_str_mv |
openAccess |
| dc.format.none.fl_str_mv |
application/pdf |
| dc.publisher.none.fl_str_mv |
European Association for the Study of the Liver |
| publisher.none.fl_str_mv |
European Association for the Study of the Liver |
| dc.source.none.fl_str_mv |
reponame:Biblos-e Archivo. Repositorio Institucional de la UAM instname:Universidad Autónoma de Madrid |
| instname_str |
Universidad Autónoma de Madrid |
| reponame_str |
Biblos-e Archivo. Repositorio Institucional de la UAM |
| collection |
Biblos-e Archivo. Repositorio Institucional de la UAM |
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|
| repository.mail.fl_str_mv |
|
| _version_ |
1869403885226950656 |
| spelling |
Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosisPraktiknjo, MichaelSimón-Talero, MacarenaRömer, JuliaRoccarina, DavideMartínez, JavierLampichler, KatharinaBaiges, AnnaLow, GavinLlop, ElbaMaurer, Martin H.Zipprich, AlexanderTriolo, MichelaMaleux, GeertFialla, Annette DamDam, ClausVidal-González, JuditMajumdar, AvikPicón, CarmenToth, DanielDarnell, AnnaAbraldes, Juan G.López, MartaJansen, ChristianChang, JohannesSchierwagen, RobertUschner, FrankKukuk, GuidoMeyer, CarstenThomas, DanielWolter, KarstenStrassburg, Christian P.Laleman, WimLa Mura, VincenzoRipoll, CristinaBerzigotti, AnnalisaCalleja Panero, José LuisTandon, PuneetaHernandez-Gea, VirginiaReiberger, ThomasAlbillos, AgustínTsochatzis, Emmanuel A.Krag, AleksanderGenescà, JoanTrebicka, JonelQuiroga, SergiYu, DominicTéllez, LuisMandorfer, MattiasGarcia-Pagan, Juan CarlosBerbel, ClaudiaFerrusquia, JoséBle, MichelGarcia-Criado, Mari AngelesBelmonte, ErnestNey, MichaelMargini, CristinaCasu, StefaniaMurgia, GiuseppeLudwig, ChristianeStangl, FranzACLFAcute decompensationAcute-on-chronic liver failureAscitesCirrhosisComputed tomographyHepatic encephalopathyPortal hypertensionSpontaneous portosystemic shuntSPSSTIPSLiveren_USMedicinaBackground & 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.Jonel Trebicka is supported by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57, CRC1382), Cellex Foundation and European Union’s Horizon 2020 research and innovation program GALAXY study (No. 668031), LIVERHOPE (No. 731875) and MICROB-PREDICT (No. 825694) and the Cellex Foundation. Joan Genescà is a recipient of a Research Intensification grant from Instituto de Salud Carlos III, Spain. The study was partially funded by grants PI15/00066, and PI18/00947 from Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, “Investing in your future”). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivasis supported by Instituto de Salud Carlos III. Macarena Simón-Talero is a recipient of the grant JR 17/00029 from Instituto de Salud Carlos IIIEuropean Association for the Study of the LiverDepartamento de MedicinaFacultad de Medicina20202020-06-01research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10486/694244https://dx.doi.org/10.1016/j.jhep.2019.12.021reponame:Biblos-e Archivo. Repositorio Institucional de la UAMinstname:Universidad Autónoma de MadridInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:repositorio.uam.es:10486/6942442026-06-23T12:46:27Z |
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