Study On The Relationship Between Portal Vein Pressure Gradient Under 7mm Shunt And Complications After TIPS

Objective:To explore the relationship between the change of portal pressure gradient under the 7mm shunt and postoperative complications of transjugular intrahepatic portal shunt,in order to better guide clinical decision-making.Methods:A total of 58 patients with portal hypertension due to cirrhosis treated with TIPS using 7mm shunt were retrospectively collected from the Department of Radiology and Interventional Therapy,Affiliated Hospital of Yunnan University from June 2018 to June 2021,including 42 males and 16 females,aged 18-76 years,with an average age of(54.83±11.20)years.Gender,age,preoperative laboratory tests(blood routine,liver and kidney function,and coagulation function)of each patient were collected.Child-Pugh score and MELD score of liver function were performed according to clinical data of each patient.Preoperative and postoperative portal vein pressure and right atrium pressure were collected.PPG related parameters were calculated(preoperative PPG,postoperative PPG,PPG percentage decline).Continuous follow-up was conducted at 4 weeks,12 weeks,24 weeks,36 weeks,48 weeks after TIPS,through telephone,outpatient or hospital visits.With dominant hepatic encephalopathy and ascites occurring within one year after TIPS surgery as the main outcome,the risk factors of OHE and ascites after TIPS surgery were determined by univariate and multivariate analysis.The predictive efficacy of PPG related parameters on OHE and ascites after TIPS was analyzed using the subject working characteristic curve,and the comparison of risk of OHE and ascites before and after the optimal cut-off point of PPG related parameters was analyzed using Kaplan-Meier survival curve.P<0.05 was considered statistically significant.Results:(1)Among all the patients,there were 42 males and 16 females,aged 18-76 years old,with an average age of(54.83±11.20)years old.In terms of PPG related indicators,the mean PPG before and after surgery was 29.26 mm Hg and 12.73 mm Hg,respectively,with an average decrease of 56% from baseline.There were 16 patients with overt hepatic encephalopathy after TIPS,with an incidence of 27.59%,17 patients with ascites or ascites worse than before,with an incidence of 29.31%,7patients with postoperative rebleeding,with an incidence of 12.07%,4patients with death,with a mortality of 6.89%,and 14 patients with no postoperative complications.(2)Univariate and multivariate analysis showed that preoperative PPG(OR:1.259,95%CI:[1.060-1.495];P=0.009)and percentage decrease in PPG(OR:1.108,95%CI:[1.011-1.214],P=0.048)were independent risk factors for hepatic encephalopathy after TIPS.Decreased percentage of PPG(OR: 0.933,95%CI :[0.872-0.998],P=0.045)was an independent risk factor for ascites after TIPS.The decrease percentage of preoperative PPG and PPG in patients with postoperative hepatic encephalopathy was greater than that in patients without postoperative hepatic encephalopathy,and the difference was statistically significant(P<0.05),there was no statistical significance in postoperative PPG between the two groups(P>0.05);The decreased percentage of PPG in postoperative ascites patients was smaller than that in patients without ascites,and the difference was statistically significant(P<0.05),there was no statistical significance in preoperative and postoperative PPG between the two groups(P>0.05).(3)In the prediction of OHE parameters,the percentage decrease of preoperative PPG and PPG AUC was 0.847(P<0.001),0.767(P<0.001),the sensitivity was0.938 and 0.688,and the specificity was 0.738 and 0.786,respectively.Preoperative PPG had better predictive performance in OHE.The cut-off point of preoperative PPG was 29.41 mm Hg,and the cut-off point of PPG decreased percentage was58.93%.In predicted postoperative ascites,the percentage of PPG decrease in AUC was 0.692(P=0.016),the sensitivity was 0.647,the specificity was 0.756,and the cut-off point was 53.57%.(4)The incidence of OHE with preoperative PPG>29.41 mm Hg was higher than that with preoperative PPG ≤ 29.41 mm Hg,and the difference was statistically significant(P < 0.001);The incidence of OHE with PPG decrease > 58.93% was greater than that with PPG decrease ≤58.93%,and the difference was statistically significant(P <0.001).In postoperative ascites,the incidence of ascites with PPG decrease≤53.57% was greater than that with PPG decrease>53.57%,the difference was statistically significant(P=0.018).Conclusions:1.Preoperative PPG and percentage decline in PPG were independent risk factors for OHE after TIPS.Decreased percentage of PPG was an independent risk factor for ascites after TIPS.2.Both preoperative PPG and the percentage decrease of PPG had predictive ability to the occurrence of postoperative OHE,and the predictive performance of preoperative PPG was good.Patients with preoperative PPG > 29.41 mm Hg and a decreased percentage of PPG > 58.93% were more likely to develop OHE after surgery.Therefore,to reduce the incidence of OHE after TIPS,PPG may need to be reduced to less than 58.93% of the original level.3.The decreased percentage of PPG has a certain ability to predict the occurrence of ascites after TIPS,but the accuracy of prediction is relatively low.The study suggested that the decreased percentage of PPG > 53.57% can reduce the occurrence of ascites after TIPS.