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Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model.
Vizzutti, Francesco; Celsa, Ciro; Calvaruso, Vincenza; Enea, Marco; Battaglia, Salvatore; Turco, Laura; Senzolo, Marco; Nardelli, Silvia; Miraglia, Roberto; Roccarina, Davide; Campani, Claudia; Saltini, Dario; Caporali, Cristian; Indulti, Federica; Gitto, Stefano; Zanetto, Alberto; Di Maria, Gabriele; Bianchini, Marcello; Pecchini, Maddalena; Aspite, Silvia; Di Bonaventura, Chiara; Citone, Michele; Guasconi, Tomas; Di Benedetto, Fabrizio; Arena, Umberto; Fanelli, Fabrizio; Maruzzelli, Luigi; Riggio, Oliviero; Burra, Patrizia; Colecchia, Antonio; Villa, Erica; Marra, Fabio; Cammà, Calogero; Schepis, Filippo.
Afiliação
  • Vizzutti F; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
  • Celsa C; Department of Health Promotion, Mother and Child Care , Internal Medicine and Medical Specialties , PROMISE, Gastroenterology and Hepatology Unit , University of Palermo , Palermo , Sicilia , Italy.
  • Calvaruso V; Department of Surgical, Oncological, and Oral Sciences (Di.Chir.On.S.) , University of Palermo , Palermo , Italy.
  • Enea M; Department of Health Promotion, Mother and Child Care , Internal Medicine and Medical Specialties , PROMISE, Gastroenterology and Hepatology Unit , University of Palermo , Palermo , Sicilia , Italy.
  • Battaglia S; Department of Health Promotion, Mother and Child Care , Internal Medicine and Medical Specialties , PROMISE, Gastroenterology and Hepatology Unit , University of Palermo , Palermo , Sicilia , Italy.
  • Turco L; Department of Economics, Business, and Statistics (SEAS) , University of Palermo , Palermo , Italy.
  • Senzolo M; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Nardelli S; Internal Medicine Unit for the Treatment of Severe Organ Failure , Dipartimento medico chirurgico delle malattie digestive, epatiche ed endocrino-metaboliche , Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna , Policlinico di Sant'Orsola , Italy.
  • Miraglia R; Multivisceral Transplant Unit-Gastroenterology , Department of Surgery, Oncology, and Gastroenterology , Padua University Hospital , Padua , Italy.
  • Roccarina D; Department of Translational and Precision Medicine , Sapienza University of Rome , Rome , Italy.
  • Campani C; Radiology Unit, Diagnostic and Therapeutic Services , IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies) , Palermo , Italy.
  • Saltini D; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
  • Caporali C; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
  • Indulti F; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Gitto S; Radiology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Zanetto A; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Di Maria G; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
  • Bianchini M; Multivisceral Transplant Unit-Gastroenterology , Department of Surgery, Oncology, and Gastroenterology , Padua University Hospital , Padua , Italy.
  • Pecchini M; Department of Health Promotion, Mother and Child Care , Internal Medicine and Medical Specialties , PROMISE, Gastroenterology and Hepatology Unit , University of Palermo , Palermo , Sicilia , Italy.
  • Aspite S; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Di Bonaventura C; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Citone M; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
  • Guasconi T; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
  • Di Benedetto F; Department of Radiology, Interventional Radiology Unit , Careggi Hospital , Florence , Italy.
  • Arena U; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Fanelli F; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit , University of Modena and Reggio Emilia , Modena , Italy.
  • Maruzzelli L; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
  • Riggio O; Department of Radiology, Interventional Radiology Unit , Careggi Hospital , Florence , Italy.
  • Burra P; Radiology Unit, Diagnostic and Therapeutic Services , IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies) , Palermo , Italy.
  • Colecchia A; Department of Translational and Precision Medicine , Sapienza University of Rome , Rome , Italy.
  • Villa E; Multivisceral Transplant Unit-Gastroenterology , Department of Surgery, Oncology, and Gastroenterology , Padua University Hospital , Padua , Italy.
  • Marra F; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Cammà C; Division of Gastroenterology , Modena Hospital , University of Modena and Reggio Emilia , Modena , Italy.
  • Schepis F; Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.
Hepatology ; 77(2): 476-488, 2023 02 01.
Article em En | MEDLINE | ID: mdl-35921493
BACKGROUND AND AIMS: Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in patients with cirrhosis with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (greater than or equal to 70 years) is debated, and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults. APPROACH AND RESULTS: We prospectively enrolled 411 consecutive patients observed at four referral centers with de novo TIPS implantation for refractory ascites or secondary prophylaxis of variceal bleeding (derivation cohort) and an external cohort of 415 patients with similar indications for TIPS (validation cohort). Older adult patients in the two cohorts were 99 and 76, respectively. A cause-specific Cox competing risks model was used to predict liver-related mortality, with orthotopic liver transplant and death for extrahepatic causes as competing events. Age, alcoholic etiology, creatinine levels, and international normalized ratio in the overall cohort, and creatinine and sodium levels in older adults were independent risk factors for liver-related death by multivariable analysis. CONCLUSIONS: After TIPS implantation, mortality is increased by aging, but TIPS placement should not be precluded in patients older than 70 years. In older adults, creatinine and sodium levels are useful predictors for decision making. Further efforts to update the prediction model with larger sample size are warranted.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Varizes Esofágicas e Gástricas / Derivação Portossistêmica Transjugular Intra-Hepática Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Aged / Humans Idioma: En Revista: Hepatology Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Itália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Varizes Esofágicas e Gástricas / Derivação Portossistêmica Transjugular Intra-Hepática Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Aged / Humans Idioma: En Revista: Hepatology Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Itália