Clinical Characteristics And Related Risk Factors Of Abnormal Liver Function After TIPS

Objective: To investigate the incidence,clinical characteristics and risk factors(RF)of liver function abnormalities induced by TIPS,and to compare several models to predict liver function abnormalities after TIPS.Materials and methods: From April 2012 to September 2020,126 patients who received TIPS and successfully implanted 8mm stent in the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University.According to whether abnormal liver function occurred after operation,patients were divided into the normal group(n=64)and abnormal group(n=62),and the incidence of postoperative abnormal liver function was calculated.All patients were followed up 1week,1 month and 3 months after surgery for alanine aminotransferase(ALT)、ascorbic aminotransferase(AST)、 total bilirubin(TB)and serum albumin(Alb).Preoperative,intraoperative and postoperative clinical data of patients in the two groups were compared and analyzed,variables with statistical significance in univariate analysis were analyzed by binary logistic regression analysis to identify the independent risk factors.Receiver operating characteristic curve(ROC)was used to compare the predictive power of relevant models for abnormal liver function after TIPS.Results: Among the 126 patients,62(49.21%)had abnormal liver function.Univariate analysis showed that there were statistical differences in Alb,international standardized ratio(INR),prothrombin time(PT),neutrophilic lymphocyte ratio(NLR),collateral embolization and puncture site between 2 groups(all P<0.05).Bichloristic logistic regression analysis showed that Alb(P=0.012,OR:0.874,95% CI :0.788-0.971),PT(P=0.001,OR:1.386,95% CI:1.139-1.687),NLR(P=0.038,OR:1.272,95% CI:1.013-1.598),combined collateral embolism(P=0.008,OR:0.255,95%CI:0.093-0.705)and puncture of left portal vein(LPV)(P=0.013,OR:0.267,95%CI:0.094-0.758)were independence risk factors for abnormal liver function after TIPS.CP score,MELD score,MELD-Na score,ALBI score,ALBI combined with PT score,preoperative NLR,and prediction model all had good predictive power for the risk of abnormal liver function after TIPS,and the prediction model was the best,with the area under curve(AUC)up to 86.4%.Conclusion: TIPS may cause some degree of liver function demage in the short term,but the effect on liver function is not significant in the medium term.Alb,PT,NLR,collateral embolization situation and puncture site were the independent risk factors,the indexes positively correlated with it were PT and NLR,combined collateral embolization and puncture LPV were negatively correlated.This predictive model can better predict the risk of postoperative abnormal liver function,but it still needs to be further verified by subsequent multi-center prosperctive clinical studies.