Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients
The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated. To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation. This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients wit...
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| Veröffentlicht in: | Digestive and liver disease 2022-01, Vol.54 (1), p.103-110 |
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| creator | Dajti, Elton Renzulli, Matteo Colecchia, Antonio Bacchi-Reggiani, Maria Letizia Milandri, Matteo Rossini, Benedetta Ravaioli, Federico Marasco, Giovanni Alemanni, Luigina Vanessa Ierardi, Anna Maria Carrafiello, Gianpaolo Pinzani, Massimo Azzaroli, Francesco Mazzella, Giuseppe Golfieri, Rita Festi, Davide |
| description | The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated.
To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation.
This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome.
SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129–6.664]. During a follow-up of 37 (20–63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259–4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016–7.070) and multiple (SHR:3.832; 95%-IC: 2.004–7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521–4.569).
The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation. |
| doi_str_mv | 10.1016/j.dld.2020.12.114 |
| format | Article |
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To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation.
This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome.
SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129–6.664]. During a follow-up of 37 (20–63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259–4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016–7.070) and multiple (SHR:3.832; 95%-IC: 2.004–7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521–4.569).
The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.</description><identifier>ISSN: 1590-8658</identifier><identifier>EISSN: 1878-3562</identifier><identifier>DOI: 10.1016/j.dld.2020.12.114</identifier><identifier>PMID: 33414086</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Chronic Disease ; Clinical Decision Rules ; Collaterals ; Elasticity Imaging Techniques ; Female ; Follow-Up Studies ; Hepatic encephalopathy ; Hepatic Encephalopathy - etiology ; Humans ; Liver Cirrhosis - complications ; Liver Cirrhosis - pathology ; Liver imaging ; Male ; Portal hypertension ; Portal Vein - abnormalities ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Vascular Malformations - complications ; Vascular Malformations - diagnosis ; Vascular Malformations - pathology</subject><ispartof>Digestive and liver disease, 2022-01, Vol.54 (1), p.103-110</ispartof><rights>2020 Editrice Gastroenterologica Italiana S.r.l.</rights><rights>Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-eaa910f343ac9380224982255232aef96ddbfafc11c2ede44b1378dca567d1643</citedby><cites>FETCH-LOGICAL-c462t-eaa910f343ac9380224982255232aef96ddbfafc11c2ede44b1378dca567d1643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1590865820311956$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33414086$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dajti, Elton</creatorcontrib><creatorcontrib>Renzulli, Matteo</creatorcontrib><creatorcontrib>Colecchia, Antonio</creatorcontrib><creatorcontrib>Bacchi-Reggiani, Maria Letizia</creatorcontrib><creatorcontrib>Milandri, Matteo</creatorcontrib><creatorcontrib>Rossini, Benedetta</creatorcontrib><creatorcontrib>Ravaioli, Federico</creatorcontrib><creatorcontrib>Marasco, Giovanni</creatorcontrib><creatorcontrib>Alemanni, Luigina Vanessa</creatorcontrib><creatorcontrib>Ierardi, Anna Maria</creatorcontrib><creatorcontrib>Carrafiello, Gianpaolo</creatorcontrib><creatorcontrib>Pinzani, Massimo</creatorcontrib><creatorcontrib>Azzaroli, Francesco</creatorcontrib><creatorcontrib>Mazzella, Giuseppe</creatorcontrib><creatorcontrib>Golfieri, Rita</creatorcontrib><creatorcontrib>Festi, Davide</creatorcontrib><title>Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients</title><title>Digestive and liver disease</title><addtitle>Dig Liver Dis</addtitle><description>The prognostic role of spontaneous portosystemic shunts (SPSS) has been poorly investigated.
To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation.
This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome.
SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129–6.664]. During a follow-up of 37 (20–63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259–4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016–7.070) and multiple (SHR:3.832; 95%-IC: 2.004–7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521–4.569).
The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.</description><subject>Chronic Disease</subject><subject>Clinical Decision Rules</subject><subject>Collaterals</subject><subject>Elasticity Imaging Techniques</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hepatic encephalopathy</subject><subject>Hepatic Encephalopathy - etiology</subject><subject>Humans</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - pathology</subject><subject>Liver imaging</subject><subject>Male</subject><subject>Portal hypertension</subject><subject>Portal Vein - abnormalities</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Vascular Malformations - complications</subject><subject>Vascular Malformations - diagnosis</subject><subject>Vascular Malformations - pathology</subject><issn>1590-8658</issn><issn>1878-3562</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtr3DAURkVpaR7tD-gmaNmNp7p62aarEJoHBLpouhYa6ZrRxLZcSRNIfn01OOmyK11dvvPBPYR8AbYBBvrbfuNHv-GM1z_fAMh35BS6tmuE0vx9nVXPmk6r7oSc5bxnjINW7CM5EUKCZJ0-JfOv8ILUzp6O0dkS4kzjQPMS52JnjIdMl5hKzM-54BQczbvDXOoyoQ-u0LJDmkJ-PEIeXZwWnPNaE2bqQkq7WCq21B1W8BP5MNgx4-fX95z8vv7xcHXb3P-8ubu6vG-c1Lw0aG0PbBBSWNeLjnEu-45zpbjgFodee78d7OAAHEePUm5BtJ13VunWg5binHxde5cU_xwwFzOF7HAc16MMl61Wqu-hrVFYoy7FnBMOZklhsunZADNHzWZvqmZz1GyAm6q5Mhev9YfthP4f8ea1Br6vAaxHPgVMJrsqwFVrCV0xPob_1P8FNWyP6g</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Dajti, Elton</creator><creator>Renzulli, Matteo</creator><creator>Colecchia, Antonio</creator><creator>Bacchi-Reggiani, Maria Letizia</creator><creator>Milandri, Matteo</creator><creator>Rossini, Benedetta</creator><creator>Ravaioli, Federico</creator><creator>Marasco, Giovanni</creator><creator>Alemanni, Luigina Vanessa</creator><creator>Ierardi, Anna Maria</creator><creator>Carrafiello, Gianpaolo</creator><creator>Pinzani, Massimo</creator><creator>Azzaroli, Francesco</creator><creator>Mazzella, Giuseppe</creator><creator>Golfieri, Rita</creator><creator>Festi, Davide</creator><general>Elsevier Ltd</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>7X8</scope></search><sort><creationdate>202201</creationdate><title>Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients</title><author>Dajti, Elton ; 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To evaluate the impact of the presence of SPSS, as well as their characteristics, on the risk of decompensation.
This is a retrospective cohort study of 235 advanced chronic liver disease (ACLD) patients with available imaging examination, transient elastography, and upper endoscopy. ACLD was defined as liver stiffness measurement (LSM) >10 kPa. Competitive risk analyses were performed to identify the factors associated with the main outcome.
SPSS were reported in 141 (60%) of the patients. Non-viral etiology was independently associated with SPSS presence [Odds-Ratio (OR): 2.743;95%-Interval-of-Confidence (IC):1.129–6.664]. During a follow-up of 37 (20–63) months, SPSS were found predictors of any decompensation type [Subhazard Ratio (SHR):2.264; 95%-IC:1.259–4.071], independently from a history of decompensation or high-risk-varices presence. The risk of complications was higher in patients with large (SHR: 3.775; 95%-IC: 2.016–7.070) and multiple (SHR:3.832; 95%-IC: 2.004–7.330) shunts, and in those with gastrorenal shunts (SHR:2.636; 95%-IC:1.521–4.569).
The presence, size, and number of SPSS predict not only the risk of hepatic encephalopathy but that of any type of decompensation across all stages of cirrhosis. Future studies should explore the possibility of treating shunts to prevent decompensation.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>33414086</pmid><doi>10.1016/j.dld.2020.12.114</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Chronic Disease Clinical Decision Rules Collaterals Elasticity Imaging Techniques Female Follow-Up Studies Hepatic encephalopathy Hepatic Encephalopathy - etiology Humans Liver Cirrhosis - complications Liver Cirrhosis - pathology Liver imaging Male Portal hypertension Portal Vein - abnormalities Predictive Value of Tests Prognosis Retrospective Studies Risk Assessment Risk Factors Vascular Malformations - complications Vascular Malformations - diagnosis Vascular Malformations - pathology |
| title | Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients |
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