TIPS insertion partially reverses systemic inflammation in patients with decompensated liver cirrhosis

Background and Aims Patients with decompensated liver cirrhosis and portal hypertension are characterized by a state of systemic inflammation (SI). Transjugular intrahepatic portosystemic shunt (TIPS)-insertion is an effective therapy for portal hypertension. The aim of this study was to investigate the impact of TIPS-insertion on SI.

Methods 177 patients receiving a TIPS at Hannover Medical School were included. C-reactive protein (CRP) and white blood cells (WBC) were analyzed in 3-year-follow-up after TIPS-insertion. In a subset of 59 patients prospectively collected plasma samples were available for a comprehensive analysis of SI by measuring 48 soluble inflammatory markers (SIM) at baseline and 1, 3, 6 months after TIPS.

Results CRP levels, but not WBC, significantly decreased after TIPS-insertion (p<0.001). Of note, CRP decline was associated with improved survival (p=0.030). Pattern of SI was similar between patients with refractory ascites (RA) and variceal bleeding except for notably elevated IL-6 levels in patients with RA (p<0.001). One month after TIPS, most SIMs remained at levels comparable to baseline with some, e.g. IL-2, even increasing. However, during further follow-up, we observed a continuous decline in most SIMs. At 6 months after TIPS 25 SIMs, including IL-6 and IL-2, showed significantly lower levels compared to baseline (FDR<0.05).

While levels of 30/48 SIMs were significantly higher in the patients’ blood compared to healthy controls at baseline, 7 of these had reversed to healthy control-levels after 6 months.

Conclusions Decreasing portal hypertension via TIPS-insertion leads to significant improvement of SI over time.

Publication History

Article published online:
23 January 2024