The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study.

Autor:	Bommena S; Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Phoenix, Arizona, USA., Mahmud N; Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA., Boike JR; Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Thornburg BG; Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois, USA., Kolli KP; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA., Lai JC; Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA., German M; Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA., Morelli G; Division of Gastroenterology, Hepatology, Department of Medicine, and Nutrition, University of Florida Health, Gainesville, Florida, USA., Spengler E; Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA., Said A; Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA., Desai AP; Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA., Junna S; Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA., Paul S; Department of Internal Medicine, Section of Gastroenterology and Nutrition, The University of Chicago Medicine, Chicago, Illinois, USA., Frenette C; Department for Organ and Cell Transplantation, The Scripps Clinic, La Jolla, California, USA., Verna EC; Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians & Surgeons, New York, New York, USA., Goel A; Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA., Gregory D; Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Padilla C; Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., VanWagner LB; Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Fallon MB; Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Phoenix, Arizona, USA.
Jazyk:	angličtina
Zdroj:	Hepatology (Baltimore, Md.) [Hepatology] 2023 Jun 01; Vol. 77 (6), pp. 2041-2051. Date of Electronic Publication: 2023 Jan 19.
DOI:	10.1097/HEP.0000000000000283
Abstrakt:	Background and Aims: Single-center studies in patients undergoing TIPS suggest that elevated right atrial pressure (RAP) may influence survival. We assessed the impact of pre-TIPS RAP on outcomes using the Advancing Liver Therapeutic Approaches (ALTA) database. Approach and Results: Total 883 patients in ALTA multicenter TIPS database from 2010 to 2015 from 9 centers with measured pre-TIPS RAP were included. Primary outcome was mortality. Secondary outcomes were 48-hour post-TIPS complications, post-TIPS portal hypertension complications, and post-TIPS inpatient admission for heart failure. Adjusted Cox Proportional hazards and competing risk model with liver transplant as a competing risk were used to assess RAP association with mortality. Restricted cubic splines were used to model nonlinear relationship. Logistic regression was used to assess RAP association with secondary outcomes.Pre-TIPS RAP was independently associated with overall mortality (subdistribution HR: 1.04 per mm Hg, 95% CI, 1.01, 1.08, p =0.009) and composite 48-hour complications. RAP was a predictor of TIPS dysfunction with increased odds of post-90-day paracentesis in outpatient TIPS, hospital admissions for renal dysfunction, and heart failure. Pre-TIPS RAP was positively associated with model for end-stage liver disease, body mass index, Native American and Black race, and lower platelets. Conclusions: Pre-TIPS RAP is an independent risk factor for overall mortality after TIPS insertion. Higher pre-TIPS RAP increased the odds of early complications and overall portal hypertensive complications as potential mechanisms for the mortality impact. (Copyright © 2023 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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