TY  - JOUR
A1  - Praktiknjo, Michael
A1  - Simón-Talero, Macarena
A1  - Römer, Julia
A1  - Roccarina, Davide
A1  - Martínez, Javier
A1  - Lampichler, Katharina
A1  - Baiges, Anna
A1  - Low, Gavin
A1  - Llop, Elba
A1  - Maurer, Martin H.
A1  - Zipprich, Alexander
A1  - Triolo, Michela
A1  - Maleux, Geert
A1  - Fialla, Annette Dam
A1  - Dam, Claus
A1  - Vidal-González, Judit
A1  - Majumdar, Avik
A1  - Picón, Carmen
A1  - Toth, Daniel
A1  - Darnell, Anna
A1  - Abraldes, Juan G.
A1  - López, Marta
A1  - Jansen, Christian
A1  - Chang, Johannes
A1  - Schierwagen, Robert
A1  - Uschner, Frank Erhard
A1  - Kukuk, Guido
A1  - Meyer, Carsten
A1  - Thomas, Daniel
A1  - Wolter, Karsten
A1  - Straßburg, Christian P.
A1  - Laleman, Wim
A1  - La Mura, Vincenzo
A1  - Ripoll, Cristina
A1  - Berzigotti, Annalisa
A1  - Calleja, José Luis
A1  - Tandon, Puneeta
A1  - Hernández-Gea, Virginia
A1  - Reiberger, Thomas
A1  - Albillos, Agustin
A1  - Tsochatzis, Emmanuel A.
A1  - Krag, Aleksander
A1  - Genescà, Joan
A1  - Trebicka, Jonel
T1  - Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis
T2  - Journal of hepatology
N2  - Background & Aims: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis.
Methods: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint.
Results: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02–2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA.
Conclusion: This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis.
Lay summary: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.
KW  - spontaneous portosystemic shunt
KW  - portosystemic shunt
KW  - SPSS
KW  - computed tomography
KW  - cirrhosis
KW  - liver
KW  - acute decompensation
KW  - portal hypertension
KW  - hepatic encephalopathy
KW  - acute-on-chronic liver failure
KW  - ACLF
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/52891
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-528913
SN  - 0168-8278
SN  - 1600-0641
N1  - © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
VL  - 72
IS  - 6
SP  - 1140
EP  - 1150
PB  - Elsevier Science ; Wiley-Blackwell
CY  - Amsterdam [u. a.]
ER  -