TY - JOUR
T1 - Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients
AU - Dajti, Elton
AU - Renzulli, Matteo
AU - Colecchia, Antonio
AU - Bacchi-Reggiani, Maria Letizia
AU - Milandri, Matteo
AU - Rossini, Benedetta
AU - Ravaioli, Federico
AU - Marasco, Giovanni
AU - Alemanni, Luigina Vanessa
AU - Ierardi, Anna Maria
AU - Carrafiello, Gianpaolo
AU - Pinzani, Massimo
AU - Azzaroli, Francesco
AU - Mazzella, Giuseppe
AU - Golfieri, Rita
AU - Festi, Davide
N1 - Funding Information:
No grants or other financial support.
Publisher Copyright:
© 2020 Editrice Gastroenterologica Italiana S.r.l.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2022
Y1 - 2022
N2 - Background: The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated. Aims: To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation. Methods: This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome. Results: SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129–6.664]. During a follow-up of 37 (20–63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259–4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016–7.070) and multiple (SHR:3.832; 95%-IC: 2.004–7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521–4.569). Conclusions: The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.
AB - Background: The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated. Aims: To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation. Methods: This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome. Results: SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129–6.664]. During a follow-up of 37 (20–63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259–4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016–7.070) and multiple (SHR:3.832; 95%-IC: 2.004–7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521–4.569). Conclusions: The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.
KW - Collaterals
KW - Hepatic encephalopathy
KW - Liver imaging
KW - Portal hypertension
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U2 - 10.1016/j.dld.2020.12.114
DO - 10.1016/j.dld.2020.12.114
M3 - Article
AN - SCOPUS:85098768367
VL - 54
SP - 103
EP - 110
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
IS - 1
ER -