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Early TIPS therapy decreases inpatient mortality for cirrhosis, EVB

HONOLULU — Researchers found that early transjugular intrahepatic portosystemic shunt treatment decreased the length of inpatient hospitalization and mortality among patients with decompensated cirrhosis and esophageal variceal bleeding, according to findings presented at ACG 2015.

“[Current studies detailing] the impact and time of TIPS and outcomes of patients is not really available at this time, so we decided to take data from a nationwide database [and analyze] the impact of the timing of TIPS and the outcomes of hospitalized patients with decompensated cirrhosis and esophageal variceal bleeding,” Basile Njei, MD, MPH, of the section of digestive diseases, Yale University School of Medicine, said during his presentation.

Njei and colleagues analyzed data of 142,539 patients from the Nationwide Inpatient Sample database with evidence of esophageal variceal bleeding (EVB) between 2000 and 2010. The patients who also showed evidence of decompensated liver disease were included in the analyses because “early TIPS is recommended” in patients who are at-risk for mortality or further bleeding, according to Njei’s presentation.

“From 2000 to 2010 the number of patients with variceal bleeding increased approximately twofold,” Njei said. “We also noticed that over this time period, there was a significant decrease in mortality rates of patients admitted for variceal bleeding.”

Between 2000 and 2010, the inpatient hospital mortality rate decreased from 656 per 100,000 per-person years to 412 per 100,000 person-years (37.2%, P < .01).

The utilization of TIPS increased over the duration of the study period for both early TIPS usage (0.22% to 0.7%) and for rescue TIPS (1.1% to 6.1%; P < .01).

Regression analysis showed an inverse association between TIPS utilization and mortality rate ratio between 2000 and 2010 (relative ratio = 0.88; 95% CI, 0.83-0.92).

Early TIPS placement had a lower rate of inpatient mortality compared with no use of TIPS (1.5% vs. 5.6%; P < .01) and the use of rescue TIPS (1.5% vs. 8.1%; P < .01).

 “Early TIPS was not associated with a higher rate of hepatic encephalopathy compared to patients with no TIPS,” Njei said during his presentation.

Njei concluded: “This nationwide database study showed that early TIPS was associated with decreased inpatient mortality and length of hospital stay in patients with decompensated cirrhosis and acute EVB. … A significant decrease in inpatient mortality among decompensated cirrhotics with EVB in the U.S. was also seen from 2000 to 2010, with a concurrent increase in the utilization of TIPS.” – by Melinda Stevens

Reference:

Njei B, et al. Abstract 70. Presented at: ACG; Oct. 16-21, 2015; Honolulu.

Disclosures: The researchers report no relevant financial disclosures.