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Hospital readmission following transjugular intrahepatic portosystemic shunt:a 14-year single-center experience

Gastroenterology Report 2020年第2期8卷 98-103,I0001页

作者： Catherine F.Vozzo Tavankit Singh Jennifer Bullen Shashank Sarvepalli Arthur McCullough baljendra kapoor Department of Internal Medicine Cleveland ClinicClevelandOHUSA Department of Gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA Department of Quantitative Health Sciences Cleveland ClinicClevelandOHUSA Department of Inflammation and Immunity Cleveland ClinicClevelandOHUSA Department of Radiology Cleveland ClinicClevelandOHUSA

Background:Placement of a transjugular intrahepatic portosystemic shunt(TIPS)is a relatively common procedure used to treat complications of portal ***,only limited data exist regarding the hospital-readmission rate after TIPS placement and no studies have addressed the causes of hospital *** therefore sought to identify the 30-day hospital-readmission rate after TIPS placement at our institution and to determine potential causes and predictors of ***:We reviewed our electronic medical-records system at our institution between 2004 and 2017 to identify patients who had undergone primary TIPS placement with polytetrafluoroethylene-covered stents and to determine the 30-day readmission rate among these patients.A series of univariable logistic-regression models were fit to assess potential predictors of 30-day ***:A total of 566 patients were included in the *** 30-day readmission rate after TIPS placement was 36%.The most common causes for readmission were confusion(48%),infection(15%),bleeding(11%),and fluid overload(7%).A higher Model for End-Stage Liver Disease(MELD)score corresponded with a higher rate of readmission(odds ratio associated with each 1-unit increase in MELD score:1.06;95%confidence interval:1.02–1.09;P=0.001).Other potential predictors,including indication for TIPS placement,were not significantly associated with a higher readmission ***:The 30-day readmission rate after TIPS placement with covered stents is high,with nearly half of these readmissions due to hepatic encephalopathy—a known complication of TIPS *** interventions to help reduce the TIPS readmission rate should be prioritized in future research.

关键词： transjugular intrahepatic portosystemic shunt portal hypertension liver cirrhosis hospital readmission

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Renal-function change after transjugular intra-hepatic portosystemic shunt placement and its relationship with survival:a single-center experience

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Gastroenterology Report 2021年第4期9卷 306-312,I0001,I0002页

作者： Min Lang Angela L.Lang Brian Q.Tsui Weiping Wang Brian K.Erly Bo Shen baljendra kapoor Department of Radiology Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA Department of Anesthesia Critical Careand Pain ManagementMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA Department of Radiology UCLA Medical CenterLos AngelesCAUSA Department of Radiology Mayo ClinicJacksonvilleFLUSA Colorado School of Public Health AuroraColoradoUSA The Inflammatory Bowel Disease Center at Columbia Columbia University Irving Medical CenterNew YorkNYUSA Division of Vascular and Interventional Radiology Imaging InstituteCleveland ClinicClevelandOHUSA

Background:The effect of transjugular intra-hepatic portosystemic shunt(TIPS)placement on renal function and the correlation of post-TIPS Cr with mortality remain *** study aimed to assess the effect of TIPS placement on renal function and to examine the relationship between post-TIPS Cr and mortality ***:A total of 593 patients who underwent de novo TIPS placement between 2004 and 2017 at a single institution were included in the *** pre-TIPS Cr level(T0;within 7 days before TIPS placement)and post-TIPS Cr levels,at 1–2 days(T1),5–12 days(T2),and 15–40 days(T3),were *** of Cr change after TIPS placement and the 1-year mortality rate were analysed using multivariable linear-regression and Cox proportional-hazards models,***:Overall,21.4%of patients(n=127)had elevated baseline Cr(≤1.5 mg/dL;mean,2.5161.49 mg/dL)and 78.6%(n=466)had normal baseline Cr(<1.5 mg/dL;mean,0.9260.26 mg/dL).Patients with elevated pre-TIPS Cr demonstrated a decrease in post-TIPS Cr(difference,-0.60 mg/dL),whereas patients with normal baseline Cr exhibited no change(difference,<0.01 mg/dL).The 30-day,90-day,and 1-year mortality rates were 13%,20%,and 32%,*** bleeding as a TIPS-placement indication(hazard ratio=1.731;P=0.036),higher T0 Cr(hazard ratio=1.834;P=0.012),and higher T3 Cr(hazard ratio=3.524;P<0.001)were associated with higher 1-year mortality ***:TIPS placement improved renal function in patients with baseline renal dysfunction and the post-TIPS Cr level was a strong predictor of 1-year mortality risk.

关键词： TIPS transjugular intra-hepatic portosystemic shunt portal hypertension renal function renal failure mortality

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Comparative study of endoscopy *** intrahepatic portosystemic shunt in the management of gastric variceal bleeding

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Gastroenterology Report 2015年第1期3卷 75-82页

作者： Gursimran Singh Kochhar Udayakumar Navaneethan Jason Hartman Jose Mari Parungao Rocio Lopez Ranjan Gupta baljendra kapoor Paresh Mehta Madhu Sanaka Department of Gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOHUSA Case Western School of Medicine ClevelandOHUSA Department of Vascular and Interventional Radiology Cleveland Clinic FoundationClevelandOHUSA

Background and Aim:Gastric varices are associated with high *** have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemic shunt(TIPS)is more effective in the treatment of gastric *** compared the outcomes of patients treated with cyanoacrylate glue or TIPS for the management of acute gastric variceal ***:The study was designed as a retrospective cohort analysis of patients undergoing either TIPS or endoscopic treatment with cyanoacrylate for acute gastric variceal bleeding at our institution from 2001 to *** compared to studied between the two treatment modalities were the short-term treatment outcomes,including re-bleeding within 30 days,length of hospital stay and in-hospital ***-Meier survival analysis was performed to assess factors associated with in-hospital ***:A total of 169 patients were included in the *** TIPS arm contained 140 patients and the cyanoacrylate arm contained 29 *** was no evidence to suggest any significant differences in demographics or disease *** were no differences between the TIPS arm and the cyanoacrylate armtwo groups in treatment outcomes including re-bleeding within 30 days(17.4%vs.17.2%;P=0.98),median length of stay in the hospital(4.5 days vs.6.0 days;P紏0.35)or in-hospital mortality(9.0%vs.11.1%;P=0.74).In-hospital mortality was evaluated for 149 patients and lower albumin(P=0.015),higher MELD score(P<0.001),higher CTP score(P=0.005)and bleeding(P=0.008)were all significantly associated with in-hospital ***:These findings suggest that both treatments are equally *** offers a safe,effective alternative to TIPS for gastric varices,and physician may choose the best therapy for each patient,factoring in the availability of TIPS or cyanoacrylate,the individual patient’s presentation,and cost.

关键词： transjugular intrahepatic portosystemic shunt(TIPS) cyanoacrylate injection gastric varices gastrointestinal bleeding

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