Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data

Autor: Luis Téllez, Rafael Ramis Barceló, José Ferrusquía-Acosta, Christophe Bureau, Qifeng Peng, Càndid Villanueva, Lise Lotte Gluud, Hui Xue, Bohan Luo, Anna Baiges, Joachim Mössner, Susana G. Rodrigues, Javier Martínez, Zhanxin Yin, Jonel Trebicka, María-Vega Catalina, Jose Miguel Marrero, Na Han, Georgina Casanovas, Weixin Ren, José Castellote, Meritxell Casas, Frederik Nevens, Salvador Augustin, Jiawei Zhong, Marta Magaz, Elba Llop, Alessandra Dell'Era, Marie Angèle Robic, Zaibo Jiang, Cristina Ripoll, Wei Bai, Xiaomei Li, Kewei Zhang, Eira Cerda, Arnulf Ferlitsch, Virginia Hernández-Gea, Fanny Turon, Chuangye He, Debora Angrisani, Karel Caca, Liliane Meireles, Stig Borbjerg Laursen, Ming Zhang, Patricia Sousa, Jie Yuan, Christian Jansen, Guilherme Macedo, Luo Zuo, Daiming Fan, Zhengyu Wang, Clemencia Guevara, Francisco Martinez-Lagares, Fuquan Ma, Jean-Pierre Vinel, P Fischer, Elena Jimenez, Jing Niu, Angel Sierra, Minhuang Sun, Maria Anna Guardascione, Junhui Sun, Jaime Bosch, Ying Zhu, Xulong Yuan, Miguel Moura, Marco Di Pascoli, Joan Genescà, Beate Appenrodt, Wengang Guo, Junjiao Dong, Yuzheng Zhuge, Ana Cruz, Daniela Reis, Patricia M. Santos, Jose Luis Calleja, Lucio Amitrano, Giulia Allegretti, Elena Peña, Oana Nicoară-Farcău, Luis Ibáñez-Samaniego, Irene Conejo, Ana Castellot, Manuel Romero-Gómez, Tianlei Yu, Tilman Sauerbruch, Guohong Han, Yong Lv, Gilberto Silva-Junior, Chunqing Zhang, Enrique Buceta, Juan Francisco Sanchez, Henning Grønbæk, Kai Li, David Haldrup, Manuel Rodríguez, Edilmar Alvarado, Álvaro Giráldez, Aleksander Krag, Rafael Bañares, Juan G. Abraldes, Andreea Pop, Qiuhe Wang, Paula Alexandrino, Marika Rudler, Raquel Diaz, Agustín Albillos, Jose Luis Mundi, Marta Gómez, Alberto Monescillo, José María Palazón, Pengxu Ding, Marco Senzolo, Guangchuan Wang, Xuan Zhu, Bogdan Procopeț, Luis Ruiz-del-Arbol, Angelo Luca, Romano Sassatelli, Yingchun Li, Carlos Noronha Ferreira, Vincenzo La Mura, Junyang Luo, Marcel Tanțău, Horia Ștefănescu, Wim Laleman, Dominique Thabut, Yongzhan Nie, Wenguang Zhang, Monica Penate, Jianbo Zhao, Juan Carlos García-Pagán, Ferran Torres, Carmen A. Navascués, Manuel Hernández-Guerra, Nuria Cañete, Massimo Primignani, Alexander Zipprich, Helena Masnou
Přispěvatelé: Ministerio de Economía y Competitividad (España), Generalitat de Catalunya, Instituto de Salud Carlos III, GORE Medical
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Preemptive TIPS Individual Data Metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups, Trebicka, J, Krag, A, Laursen, S B, Gluud, L L, Grønbæk, H & Haldrup, D 2021, ' Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding : a Meta-analysis of Individual Patient Data ', Gastroenterology, vol. 160, no. 1, pp. 193-205.e10 . https://doi.org/10.1053/j.gastro.2020.09.026
Digital.CSIC. Repositorio Institucional del CSIC
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Preemptive TIPS Individual Data Metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups 2021, ' Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding : a Meta-analysis of Individual Patient Data ', Gastroenterology, vol. 160, no. 1, pp. 193–205 . https://doi.org/10.1053/j.gastro.2020.09.026
Digital.CSIC: Repositorio Institucional del CSIC
Consejo Superior de Investigaciones Científicas (CSIC)
Nicoară-Farcău, O, Han, G, Rudler, M, Angrisani, D, Monescillo, A, Torres, F, Casanovas, G, Bosch, J, Lv, Y, Thabut, D, Fan, D, Hernández-Gea, V, García-Pagán, J C & preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups 2021, ' Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding : a Meta-analysis of Individual Patient Data ', Gastroenterology, vol. 160, no. 1, pp. 193-205.e10 . https://doi.org/10.1053/j.gastro.2020.09.026
DOI: 10.1053/j.gastro.2020.09.026
Popis: Preemptive TIPS Individual Data Metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups.
[Background & Aims] Compared with drugs plus endoscopy, placement of transjugular portosystemic shunt within 72 hours of admission to the hospital (early or preventive transjugular intrahepatic portosystemic shunt [TIPS], also called preemptive TIPS) increases the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survive for 1 year. However, the benefit of preemptive TIPS is less clear for patients with a Child-Pugh score of B and active bleeding (CP-B+AB). We performed an individual data meta-analysis to assess the efficacy of preemptive TIPS in these patients and identify factors associated with reduced survival of patients receiving preemptive TIPS.
[Method] We searched publication databases for randomized controlled trials and observational studies comparing the effects of preemptive TIPS versus endoscopy plus nonselective beta-blockers in the specific population of high-risk patients with cirrhosis and acute variceal bleeding (CP-B+AB or Child-Pugh C, below 14 points), through December 31, 2019. We performed a meta-analysis of data from 7 studies (3 randomized controlled trials and 4 observational studies), comprising 1327 patients (310 received preemptive TIPS and 1017 received drugs plus endoscopy). We built adjusted models to evaluate risk using propensity score for baseline covariates. Multivariate Cox regression models were used to assess the factors associated with survival time. The primary endpoint was effects of preemptive TIPS versus drugs plus endoscopy on 1-year survival in the overall population as well as CP-B+AB and Child-Pugh C patients.
[Results] Overall, preemptive TIPS significantly increased the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survived for 1 year, compared with drugs plus endoscopy (hazard ratio [HR] 0.443; 95% CI 0.323–0.607; P < .001). This effect was observed in CP-B+AB patients (HR 0.524; 95% CI 0.307–0.896; P = .018) and in patients with Child-Pugh C scores below 14 points (HR 0.374; 95% CI 0.253–0.553; P < .001). Preemptive TIPS significantly improved control of bleeding and ascites without increasing risk of hepatic encephalopathy in Child-Pugh C and CP-B+AB patients, compared with drugs plus endoscopy. Cox analysis of patients who received preemptive TIPS showed that patients could be classified into 3 categories for risk of death, based on age, serum level of creatinine, and Child-Pugh score. In each of these risk categories, preemptive TIPS increased the proportion of patients who survived for 1 year, compared with drugs plus endoscopy.
[Conclusions] In a meta-analysis of data from 1327 patients with cirrhosis, acute variceal bleeding, and Child-Pugh score between 10 and 13 points or CP-B+AB, preemptive TIPS increased the proportion who survived for 1 year, in both subgroups separately, compared with drugs plus endoscopy.
Juan Carlos García-Pagán received support in part through grants from the Spanish Ministry of Education and Science (SAF-2016–75767-R and PIE 15/00027) and from the “Commissioner for Universities and Research of the Generalitat de Catalunya” (AGAUR SGR 2017). CIBERehd is funded by the Instituto de Salud Carlos III. Edilmar Alvarado-Tapias and Anna Baiges are recipients of a "Río Hortega" fellowship grant from the Instituto de Salud Carlos III. The study was partially supported by a GORE grant for statistical support.
Databáze: OpenAIRE
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