TY - JOUR
T1 - The impact of right atrial pressure on outcomes in patients undergoing TIPS, an ALTA group study
AU - Advancing Liver Therapeutic Approaches (ALTA) Study Group
AU - Bommena, Shoma
AU - Mahmud, Nadim
AU - Boike, Justin R.
AU - Thornburg, Bartley G.
AU - Kolli, Kanti P.
AU - Lai, Jennifer C.
AU - German, Margarita
AU - Morelli, Giuseppe
AU - Spengler, Erin
AU - Said, Adnan
AU - Desai, Archita P.
AU - Junna, Shilpa
AU - Paul, Sonali
AU - Frenette, Catherine
AU - Verna, Elizabeth C.
AU - Goel, Aparna
AU - Gregory, Dyanna
AU - Padilla, Cynthia
AU - Vanwagner, Lisa B.
AU - Fallon, Michael B.
N1 - Publisher Copyright:
Copyright © 2023 American Association for the Study of Liver Diseases.
PY - 2023/6
Y1 - 2023/6
N2 - Background and Aims: Single-center studies in patients undergoing 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. Approach and Results: Total 883 patients in ALTA multicenter TIPS database from 2010 to 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. 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 nonlinear relationship. Logistic regression was used to assess RAP association with secondary outcomes. Pre-TIPS RAP was independently associated with overall mortality (subdistribution HR: 1.04 per mm Hg, 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 heart failure. Pre-TIPS RAP was positively associated with model for end-stage liver disease, body mass index, Native American and Black race, and lower platelets. Conclusions: Pre-TIPS RAP is an independent risk factor for overall mortality after TIPS insertion. Higher pre-TIPS RAP increased the odds of early complications and overall portal hypertensive complications as potential mechanisms for the mortality impact.
AB - Background and Aims: Single-center studies in patients undergoing 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. Approach and Results: Total 883 patients in ALTA multicenter TIPS database from 2010 to 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. 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 nonlinear relationship. Logistic regression was used to assess RAP association with secondary outcomes. Pre-TIPS RAP was independently associated with overall mortality (subdistribution HR: 1.04 per mm Hg, 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 heart failure. Pre-TIPS RAP was positively associated with model for end-stage liver disease, body mass index, Native American and Black race, and lower platelets. Conclusions: Pre-TIPS RAP is an independent risk factor for overall mortality after TIPS insertion. Higher pre-TIPS RAP increased the odds of early complications and overall portal hypertensive complications as potential mechanisms for the mortality impact.
UR - http://www.scopus.com/inward/record.url?scp=85159739107&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85159739107&partnerID=8YFLogxK
U2 - 10.1097/HEP.0000000000000283
DO - 10.1097/HEP.0000000000000283
M3 - Article
C2 - 36651170
AN - SCOPUS:85159739107
SN - 0270-9139
VL - 77
SP - 2041
EP - 2051
JO - Hepatology
JF - Hepatology
IS - 6
ER -