Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion
Background and Aim This study aimed to identify predictors of model for end‐stage liver disease sodium score reductions and improvements in vital prognoses following portosystemic shunt occlusion in portal hypertension patients. Methods Seventy cirrhotic patients with major portosystemic shunts and...
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| Veröffentlicht in: | Journal of gastroenterology and hepatology 2019-01, Vol.34 (1), p.215-223 |
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| creator | Ishikawa, Tsuyoshi Sasaki, Ryo Nishimura, Tatsuro Matsuda, Takashi Maeda, Masaki Iwamoto, Takuya Saeki, Issei Hidaka, Isao Takami, Taro Sakaida, Isao |
| description | Background and Aim
This study aimed to identify predictors of model for end‐stage liver disease sodium score reductions and improvements in vital prognoses following portosystemic shunt occlusion in portal hypertension patients.
Methods
Seventy cirrhotic patients with major portosystemic shunts and a mean model for end‐stage liver disease sodium score of 10.5 underwent balloon‐occluded retrograde transvenous obliteration between February 2008 and March 2017. We calculated the scores before and 1 month after shunt occlusion. The long‐term outcomes were monitored, and vital prognoses were analyzed.
Results
The model for end‐stage liver disease sodium score did not change significantly 1 month post‐balloon‐occluded retrograde transvenous obliteration, and the score decreased postoperatively in 31 (44.3%) patients. Univariate analyses showed that decline in the score after portosystemic shunt occlusion was strongly associated with hepatic encephalopathy as a procedural indication, lower liver volumes, and lower liver stiffness levels measured by transient elastography before treatment (P |
| doi_str_mv | 10.1111/jgh.14410 |
| format | Article |
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This study aimed to identify predictors of model for end‐stage liver disease sodium score reductions and improvements in vital prognoses following portosystemic shunt occlusion in portal hypertension patients.
Methods
Seventy cirrhotic patients with major portosystemic shunts and a mean model for end‐stage liver disease sodium score of 10.5 underwent balloon‐occluded retrograde transvenous obliteration between February 2008 and March 2017. We calculated the scores before and 1 month after shunt occlusion. The long‐term outcomes were monitored, and vital prognoses were analyzed.
Results
The model for end‐stage liver disease sodium score did not change significantly 1 month post‐balloon‐occluded retrograde transvenous obliteration, and the score decreased postoperatively in 31 (44.3%) patients. Univariate analyses showed that decline in the score after portosystemic shunt occlusion was strongly associated with hepatic encephalopathy as a procedural indication, lower liver volumes, and lower liver stiffness levels measured by transient elastography before treatment (P < 0.05). Multivariate logistic regression analysis identified preoperative liver stiffness level as an independent predictor of model for end‐stage liver disease sodium score amelioration following balloon‐occluded retrograde transvenous obliteration (P < 0.05), and receiver operating characteristic curve analysis determined a liver stiffness cutoff value of 21.6 kPa, with a sensitivity of 76.0% and specificity of 69.6%. The Kaplan–Meier method determined that overall survival rates after treatment in patients with liver stiffness < 21.6 kPa were significantly higher than in patients with liver stiffness ≥ 21.6 kPa (P < 0.05).
Conclusions
Liver stiffness measured by transient elastography may predict improvements in model for end‐stage liver disease sodium scores and in survival rates after portosystemic shunt occlusion in portal hypertension patients.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.14410</identifier><identifier>PMID: 30070412</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Balloon Occlusion ; balloon‐occluded retrograde transvenous obliteration ; Elasticity ; Elasticity Imaging Techniques ; End Stage Liver Disease - blood ; Esophageal and Gastric Varices - etiology ; Esophageal and Gastric Varices - therapy ; Female ; Hepatic encephalopathy ; Hepatic Encephalopathy - etiology ; Hepatic Encephalopathy - therapy ; Humans ; Hypertension ; Hypertension, Portal - complications ; Liver Cirrhosis - blood ; Liver Cirrhosis - complications ; Liver Cirrhosis - diagnostic imaging ; Liver Cirrhosis - physiopathology ; Liver diseases ; liver stiffness ; Male ; Middle Aged ; model for end‐stage liver disease sodium score ; Occlusion ; Patients ; Portasystemic Shunt, Surgical ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Shunts ; Sodium ; Sodium - blood ; Survival ; Survival Rate ; transient elastography</subject><ispartof>Journal of gastroenterology and hepatology, 2019-01, Vol.34 (1), p.215-223</ispartof><rights>2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><rights>2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><rights>2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4540-18aa156a0430500665955ce9cdb3c9bf0008c4f5239d6654a280950f56621583</citedby><cites>FETCH-LOGICAL-c4540-18aa156a0430500665955ce9cdb3c9bf0008c4f5239d6654a280950f56621583</cites><orcidid>0000-0003-3722-3083</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.14410$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.14410$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,45583,45584</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30070412$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ishikawa, Tsuyoshi</creatorcontrib><creatorcontrib>Sasaki, Ryo</creatorcontrib><creatorcontrib>Nishimura, Tatsuro</creatorcontrib><creatorcontrib>Matsuda, Takashi</creatorcontrib><creatorcontrib>Maeda, Masaki</creatorcontrib><creatorcontrib>Iwamoto, Takuya</creatorcontrib><creatorcontrib>Saeki, Issei</creatorcontrib><creatorcontrib>Hidaka, Isao</creatorcontrib><creatorcontrib>Takami, Taro</creatorcontrib><creatorcontrib>Sakaida, Isao</creatorcontrib><title>Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background and Aim
This study aimed to identify predictors of model for end‐stage liver disease sodium score reductions and improvements in vital prognoses following portosystemic shunt occlusion in portal hypertension patients.
Methods
Seventy cirrhotic patients with major portosystemic shunts and a mean model for end‐stage liver disease sodium score of 10.5 underwent balloon‐occluded retrograde transvenous obliteration between February 2008 and March 2017. We calculated the scores before and 1 month after shunt occlusion. The long‐term outcomes were monitored, and vital prognoses were analyzed.
Results
The model for end‐stage liver disease sodium score did not change significantly 1 month post‐balloon‐occluded retrograde transvenous obliteration, and the score decreased postoperatively in 31 (44.3%) patients. Univariate analyses showed that decline in the score after portosystemic shunt occlusion was strongly associated with hepatic encephalopathy as a procedural indication, lower liver volumes, and lower liver stiffness levels measured by transient elastography before treatment (P < 0.05). Multivariate logistic regression analysis identified preoperative liver stiffness level as an independent predictor of model for end‐stage liver disease sodium score amelioration following balloon‐occluded retrograde transvenous obliteration (P < 0.05), and receiver operating characteristic curve analysis determined a liver stiffness cutoff value of 21.6 kPa, with a sensitivity of 76.0% and specificity of 69.6%. The Kaplan–Meier method determined that overall survival rates after treatment in patients with liver stiffness < 21.6 kPa were significantly higher than in patients with liver stiffness ≥ 21.6 kPa (P < 0.05).
Conclusions
Liver stiffness measured by transient elastography may predict improvements in model for end‐stage liver disease sodium scores and in survival rates after portosystemic shunt occlusion in portal hypertension patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Balloon Occlusion</subject><subject>balloon‐occluded retrograde transvenous obliteration</subject><subject>Elasticity</subject><subject>Elasticity Imaging Techniques</subject><subject>End Stage Liver Disease - blood</subject><subject>Esophageal and Gastric Varices - etiology</subject><subject>Esophageal and Gastric Varices - therapy</subject><subject>Female</subject><subject>Hepatic encephalopathy</subject><subject>Hepatic Encephalopathy - etiology</subject><subject>Hepatic Encephalopathy - therapy</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Portal - complications</subject><subject>Liver Cirrhosis - blood</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - diagnostic imaging</subject><subject>Liver Cirrhosis - physiopathology</subject><subject>Liver diseases</subject><subject>liver stiffness</subject><subject>Male</subject><subject>Middle Aged</subject><subject>model for end‐stage liver disease sodium score</subject><subject>Occlusion</subject><subject>Patients</subject><subject>Portasystemic Shunt, Surgical</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Shunts</subject><subject>Sodium</subject><subject>Sodium - blood</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>transient elastography</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1rGzEQhkVJaBynh_6BIsglOTge7Ura1bGEfLQYcsldyLJky-yuXI22Yf99lTjNodC5DIMeHmb0EvKVwQ0rtdxvdzeMcwafyKx0WLCGyxMyg5aJhaqZOiPniHsA4NCIz-SsBmiAs2pG8ir8doliDt4PDpH2zuCY3IauJ5qTGTC4IVPXGcxxm8xhN1GD9FCIYHNMNPoyxO0Q0SH1seviSxi29BBTjjhhdn2wFHdjkURruxFDHC7IqTcdui_vfU6e7--ebx8Xq6eHH7ffVwvLxesVrTFMSAO8BgEgpVBCWKfsZl1btfblntZyL6pabcojN1ULSoAXUlZMtPWcXB21ZcFfo8Os-4DWdZ0ZXBxRV9BWoCpZq4Je_oPu45iGspyumJSylU0jCnV9pGyKiMl5fUihN2nSDPRrErokod-SKOy3d-O47t3mg_z79QVYHoGX0Lnp_yb98-HxqPwDmQ6TAw</recordid><startdate>201901</startdate><enddate>201901</enddate><creator>Ishikawa, Tsuyoshi</creator><creator>Sasaki, Ryo</creator><creator>Nishimura, Tatsuro</creator><creator>Matsuda, Takashi</creator><creator>Maeda, Masaki</creator><creator>Iwamoto, Takuya</creator><creator>Saeki, Issei</creator><creator>Hidaka, Isao</creator><creator>Takami, Taro</creator><creator>Sakaida, Isao</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3722-3083</orcidid></search><sort><creationdate>201901</creationdate><title>Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion</title><author>Ishikawa, Tsuyoshi ; Sasaki, Ryo ; Nishimura, Tatsuro ; Matsuda, Takashi ; Maeda, Masaki ; Iwamoto, Takuya ; Saeki, Issei ; Hidaka, Isao ; Takami, Taro ; Sakaida, Isao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4540-18aa156a0430500665955ce9cdb3c9bf0008c4f5239d6654a280950f56621583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Balloon Occlusion</topic><topic>balloon‐occluded retrograde transvenous obliteration</topic><topic>Elasticity</topic><topic>Elasticity Imaging Techniques</topic><topic>End Stage Liver Disease - blood</topic><topic>Esophageal and Gastric Varices - etiology</topic><topic>Esophageal and Gastric Varices - therapy</topic><topic>Female</topic><topic>Hepatic encephalopathy</topic><topic>Hepatic Encephalopathy - etiology</topic><topic>Hepatic Encephalopathy - therapy</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Portal - complications</topic><topic>Liver Cirrhosis - blood</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - diagnostic imaging</topic><topic>Liver Cirrhosis - physiopathology</topic><topic>Liver diseases</topic><topic>liver stiffness</topic><topic>Male</topic><topic>Middle Aged</topic><topic>model for end‐stage liver disease sodium score</topic><topic>Occlusion</topic><topic>Patients</topic><topic>Portasystemic Shunt, Surgical</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Shunts</topic><topic>Sodium</topic><topic>Sodium - blood</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>transient elastography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ishikawa, Tsuyoshi</creatorcontrib><creatorcontrib>Sasaki, Ryo</creatorcontrib><creatorcontrib>Nishimura, Tatsuro</creatorcontrib><creatorcontrib>Matsuda, Takashi</creatorcontrib><creatorcontrib>Maeda, Masaki</creatorcontrib><creatorcontrib>Iwamoto, Takuya</creatorcontrib><creatorcontrib>Saeki, Issei</creatorcontrib><creatorcontrib>Hidaka, Isao</creatorcontrib><creatorcontrib>Takami, Taro</creatorcontrib><creatorcontrib>Sakaida, Isao</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ishikawa, Tsuyoshi</au><au>Sasaki, Ryo</au><au>Nishimura, Tatsuro</au><au>Matsuda, Takashi</au><au>Maeda, Masaki</au><au>Iwamoto, Takuya</au><au>Saeki, Issei</au><au>Hidaka, Isao</au><au>Takami, Taro</au><au>Sakaida, Isao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2019-01</date><risdate>2019</risdate><volume>34</volume><issue>1</issue><spage>215</spage><epage>223</epage><pages>215-223</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Background and Aim
This study aimed to identify predictors of model for end‐stage liver disease sodium score reductions and improvements in vital prognoses following portosystemic shunt occlusion in portal hypertension patients.
Methods
Seventy cirrhotic patients with major portosystemic shunts and a mean model for end‐stage liver disease sodium score of 10.5 underwent balloon‐occluded retrograde transvenous obliteration between February 2008 and March 2017. We calculated the scores before and 1 month after shunt occlusion. The long‐term outcomes were monitored, and vital prognoses were analyzed.
Results
The model for end‐stage liver disease sodium score did not change significantly 1 month post‐balloon‐occluded retrograde transvenous obliteration, and the score decreased postoperatively in 31 (44.3%) patients. Univariate analyses showed that decline in the score after portosystemic shunt occlusion was strongly associated with hepatic encephalopathy as a procedural indication, lower liver volumes, and lower liver stiffness levels measured by transient elastography before treatment (P < 0.05). Multivariate logistic regression analysis identified preoperative liver stiffness level as an independent predictor of model for end‐stage liver disease sodium score amelioration following balloon‐occluded retrograde transvenous obliteration (P < 0.05), and receiver operating characteristic curve analysis determined a liver stiffness cutoff value of 21.6 kPa, with a sensitivity of 76.0% and specificity of 69.6%. The Kaplan–Meier method determined that overall survival rates after treatment in patients with liver stiffness < 21.6 kPa were significantly higher than in patients with liver stiffness ≥ 21.6 kPa (P < 0.05).
Conclusions
Liver stiffness measured by transient elastography may predict improvements in model for end‐stage liver disease sodium scores and in survival rates after portosystemic shunt occlusion in portal hypertension patients.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30070412</pmid><doi>10.1111/jgh.14410</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3722-3083</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Balloon Occlusion balloon‐occluded retrograde transvenous obliteration Elasticity Elasticity Imaging Techniques End Stage Liver Disease - blood Esophageal and Gastric Varices - etiology Esophageal and Gastric Varices - therapy Female Hepatic encephalopathy Hepatic Encephalopathy - etiology Hepatic Encephalopathy - therapy Humans Hypertension Hypertension, Portal - complications Liver Cirrhosis - blood Liver Cirrhosis - complications Liver Cirrhosis - diagnostic imaging Liver Cirrhosis - physiopathology Liver diseases liver stiffness Male Middle Aged model for end‐stage liver disease sodium score Occlusion Patients Portasystemic Shunt, Surgical Predictive Value of Tests Prognosis Retrospective Studies Severity of Illness Index Shunts Sodium Sodium - blood Survival Survival Rate transient elastography |
| title | Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion |
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