Lack of porto-caval gradient (PCG) increase after transjugular intrahepatic portosystemic shunt (TIPS) implantation under deep sedation is associated to poor survival

Previous data have shown that PCG measured during TIPS placement with sedation differs from PCG measured 24 hours later without sedation (Silva-Junior et al., Gastroenterology 2017). However, the association between these difference (ΔPCG) and clinical relevance remains unclear. Therefore, our aim was to investigate prospectively the influence of ΔPCG on survival.

Methods 48 patients with TIPS implantation due to refractory ascites were included. TIPS placement was done under deep sedation using propofol, midazolam and pethidine. A measurement of PCG was performed directly after TIPS placement and 24h later without sedation (24h PCG). Inclusion time 01/2018–08/2021. Variables were compared with U-Mann-Whitney. Kaplan-Meyer curves were constructed and compared with log-rank test.

Results PCG was higher without sedation (ΔPCG; mean±SD: +2.4±3.5 mmHg, p < 0.0001). In 33 (69%) pts ΔPCG increased (+4.3±2.3 mmHg), in 15 (31%) pts ΔPCG showed no increase (-1.6±1.8 mmHg). There were no differences between both groups regarding age, MELD, CP score, bilirubin, creatinine, albumin, PP, and EF before or ASAT, ALAT, lactate, blood pressure, and heart frequency 24 h after TIPS placement. On survival analysis, pts without 24hPCG increase had a higher risk of death than pts with 24h PCG increase (p < 0.0009).

Conclusion Lack of increase of 24hPCG after TIPS is associated with poor survival. Clinical and hemodynamic variables evaluated at baseline were not associated to ΔPCG. No clinical or hemodynamical variables evaluated at the time of 24hPCG could further explain the association with survival. Further investigation is needed to evaluate the mechanisms involved.

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Artikel online veröffentlicht:
26. Januar 2022