Inpatient Mortality Benefit with Transjugular Intrahepatic Portosystemic Shunt for Hospitalized Hepatorenal Syndrome Patients

AbstractBackgroundIt has been reported that transjugular intrahepatic portosystemic shunting (TIPS) might be utilized as a salvage option for hepatorenal syndrome (HRS), while randomized controlled trials are pending and real-world contemporary data on inpatient mortality is lacking.MethodsWe conducted an observational retrospective cohort study from the National Inpatient Sample from 2005 to 2014. We included all adult patients admitted with HRS and cirrhosis, using ICD 9-CM codes. We excluded cases with variceal bleeding, Budd –Chiari, end-stage renal disease, liver transplant and transfers to acute-care facilities. TIPS’ association with inpatient mortality was assessed using multivariable mixed-effects logistic regression, as well as exact-matching, thus mitigating for TIPS selection bias. The exact-matched analy sis was repeated among TIPS-only versus dialysis-only patients.ResultsA total of 79,354 patients were included. Nine hundred eighteen (1.2%) underwent TIPS. Between TIPS and non-TIPS groups, mean age (58  years) and gender (65% males) were similar. Overall mortality was 18% in TIPS and 48% in dialysis-only cases (n = 10,379; 13.1%). Ninety six (10.5%) TIPS patients underwent dialysis. In-hospital mortality in TIPS patients was twice less likely than in non-TIPS patients (adjusted odds ratio [aOR] = 0.43, 95% CI 0.30–0.62;p 
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research

Related Links:

Objectives: Biliary atresia (BA) is the most common reason for liver transplant in childhood, and outcomes worsen with older age at hepatoportoenterostomy (HPE). We determined direct health care costs in children with BA, compared to controls in a population-based cohort of children in Ontario, Canada. Methods: We used health administrative data to identify all children diagnosed with BA between 2002 and 2016 (n = 121) and matched controls (n = 602). We determined annual direct healthcare costs, and rates of health services utilization, liver transplantation, death, portal hypertension, cirrhosis, esophageal v...
Source: Journal of Pediatric Gastroenterology and Nutrition - Category: Gastroenterology Tags: Original Articles: Hepatology Source Type: research
Authors: Pérez-Cuadrado Robles E, Perrod G, Moreels TG, Zamora Nava LE, Blanco Velasco G, Esteban Delgado P, Samaha E, Hernández-Mondragón ÓV, Rahmi G, Cellier C Abstract INTRODUCTION: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. METHODS: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions...
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
In this study, we aimed to evaluate the clinical features, etiological factors, medications, morbidity, mortality, and obstetric outcomes of pregnant women with hepatic cirrhosis. Methods: Pregnant women, who were diagnosed with maternal hepatic cirrhosis and followed up in our clinic between 2014 and 2017, were retrospectively evaluated. The pregnant women that had been followed up for hepatic cirrhosis were classified as compensated disease and decompensated disease. Eleven cases were included in this period. Results: The mean age of cases was 33.5 ± 5.5 years. The mean gravida number was 3.2 &plusm...
Source: Gastroenterology Research and Practice - Category: Gastroenterology Tags: Gastroenterol Res Pract Source Type: research
we found of interest the paper by Lu et al. on the outcome after percutaneous coronary intervention in patients with cirrhosis.1 In these patients they observed a much higher frequency of overall adverse events (44.7% vs 17.7%); most importantly, gastrointestinal bleeding was increased more than five times (15.3% vs 2.7%).1 We believe this paper should gain wide diffusion among practicing gastroenterologists, and cardiologists, as acute myocardial infarction is increasing among cirrhosis patients, also in the USA.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Meta ‐analysis of 2 × 2 tables is common and useful in research topics including analysis of adverse events and survey research data. Fixed‐effects inference typically centers on measures of association such as the Cochran‐Mantel‐Haenszel statistic or Woolf's estimator, but relies on assuming exact homogeneity across studies, which is often unrealistic. By showing that estimators of several widely‐used methods have meaningful estimands even in the presence of heterogeneity, we derive improved confidence intervals for them under heterogeneity. These improvements over current methods are illustrated by...
Source: Research Synthesis Methods - Category: Chemistry Authors: Tags: RESEARCH ARTICLE Source Type: research
Purpose of review ICU admissions due to complications of advanced liver disease continue to rise. Among indications for admission to the ICU in patients with cirrhosis, gastrointestinal issues such as bleeding are common. In patients in whom gastrointestinal issues are not the principal indication for ICU, gastrointestinal issues such as nutrition and ileus remain important concerns for generalized intensive care support. This review highlights current trends in management of gastrointestinal issues in patients with cirrhosis admitted to the ICU. Recent findings General management of upper gastrointestinal bleeding re...
Source: Current Opinion in Critical Care - Category: Nursing Tags: GASTROINTESTINAL SYSTEM: Edited by Ram M. Subramanian Source Type: research
AbstractBariatric and metabolic surgery is associated with significant improvement in obesity-related comorbidities, but for patients with non-alcoholic fatty liver disease (NAFLD), clinical outcomes are dependent on the severity of liver disease, i.e. improvement of NAFLD in most patients but increased risks of fulminant hepatic failure and/or bleeding varices in patients with more advanced cirrhosis. Our study showed that absolute values of liver enzymes were poor indicator of risk of liver fibrosis. The use of AST/ALT ratio, Fib 4 or NAFLD scores were appropriate screening tools, with each risk score appearing to pick o...
Source: Obesity Surgery - Category: Surgery Source Type: research
This study aimed to investigate the characteristics of second UE for liver cirrhosis with EVB and further examined the potential prognostic factors. Patients aged ≥18 years who underwent UE for EVB within 2 hours after the admission were included and divided into scheduled second-look group (n = 245) and uncontrolled bleeding group (n = 352) based on the indications for second UE within 48 hours after initial endoscopy. Demographic and clinical data were collected and analyzed. Univariate and multivariate analysis were used to identify the risk factors for prognosis. The value of different scoring system wa...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
Liver cirrhotic predisposes patients to coagulopathy and bleeding. Little is known about outcomes of acute myocardial infarction (AMI) in cirrhotic patients. Data from Taiwan National Health Insurance Research Database during 2001 to 2013 were retrieved for patients admitted with cirrhosis and AMI. We excluded patients with missing information,
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
This article is protected by copyright. All rights reserved.
Source: Research Synthesis Methods - Category: Chemistry Authors: Tags: RESEARCH ARTICLE Source Type: research
More News: Bleeding | Cirrhosis | Dialysis | Gastroenterology | Liver | Liver Transplant | Study | Transplant Surgery | Transplants | Urology & Nephrology