Gender Disparity in Inpatient Mortality After Transjugular Intrahepatic Portosystemic Shunt Creation in Patients Admitted With Hepatorenal Syndrome: A Nationwide Study
| Autor: | Paul J. Rochon, Matthew A. Brown, Robert K. Ryu, Premal S. Trivedi, D. Thor Johnson |
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| Rok vydání: | 2019 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Cirrhosis Hepatorenal Syndrome medicine.medical_treatment Disease Logistic regression 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Hepatorenal syndrome Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Retrospective Studies Inpatients Framingham Risk Score business.industry Odds ratio medicine.disease Confidence interval Logistic Models Treatment Outcome 030220 oncology & carcinogenesis Female Portasystemic Shunt Transjugular Intrahepatic business Transjugular intrahepatic portosystemic shunt |
| Zdroj: | Journal of the American College of Radiology : JACR. 17(2) |
| ISSN: | 1558-349X |
| Popis: | PURPOSE The aim of this study was to evaluate inpatient mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation compared with medical management (MM) in patients with hepatorenal syndrome (HRS). METHODS Patients with cirrhosis admitted with HRS between 2005 and 2014 were identified using associated International Classification of Diseases, Ninth Revision, codes in the National Inpatient Sample (n = 153,112). Non-TIPS candidates and patients with parenchymal renal disease were excluded (n = 73,454). The remaining admissions were assigned to groups of TIPS (International Classification of Diseases, Ninth Revision, code 39.1; n = 971) or MM (n = 78,687). Inpatient mortality was analyzed by treatment type and patient gender using χ2 tests. Logistic regression was performed to control for baseline differences in patient demographics, comorbid disease, and pretreatment mortality risk. RESULTS Baseline patient demographics were similar. Patients treated medically had higher baseline disease severity (median mortality risk score, 8.3 with MM versus 6.1 with TIPS; P < .01). Inpatient mortality was strongly modified by patient gender. TIPS creation conferred inpatient mortality benefit in men (28% of the MM group versus 10% of the TIPS group, P < .01) independent of all covariates (odds ratio, 0.4; 95% confidence interval, 0.17-0.78; P < .01). Women treated with TIPS creation experienced no mortality benefit (29% MM versus 32% TIPS; odds ratio, 1.5; 95% confidence interval, 0.75-3.23; P = .23). CONCLUSIONS TIPS creation is associated with reduced inpatient mortality in men, but not women, admitted with HRS. Drivers of this gender-based disparity are currently unclear and warrant focused investigation. |
| Databáze: | OpenAIRE |
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