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

The impact of right atrial pressure on outcomes in patients undergoing TIPS, An ALTA group study. Hepatology (Baltimore, Md.) Bommena, S., Mahmud, N., Boike, J. R., Thornburg, B. G., Kolli, K. P., Lai, J. C., German, M., Morelli, G., Spengler, E., Said, A., Desai, A. P., Junna, S., Paul, S., Frenette, C., Verna, E. C., Goel, A., Gregory, D., Padilla, C., VanWagner, L. B., Fallon, M. B. 2023

Abstract

Single-center studies in patients undergoing transjugular intrahepatic portosystemic shunt (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.883 patients in ALTA multicenter TIPS database from 2010-2015 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 (HF). 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 non-linear relationship. Logistic regression was used to assess RAP association with secondary outcomes.Pre-TIPS RAP was independently associated with overall mortality (sHR 1.04 per mmHg, 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 HF. Pre-TIPS RAP was positively associated with MELD, BMI, Native American and Black race, and lower platelets.Pre-TIPS RAP is an independent risk factor for overall mortality following TIPS insertion. Higher pre-TIPS RAP increased the odds of early complications and overall portal hypertensive complications as potential mechanisms for the mortality impact.

View details for DOI 10.1097/HEP.0000000000000283

View details for PubMedID 36651170