Inpatient Mortality Benefit with Transjugular Intrahepatic Portosystemic Shunt for Hospitalized Hepatorenal Syndrome Pat
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ORIGINAL ARTICLE
Inpatient Mortality Benefit with Transjugular Intrahepatic Portosystemic Shunt for Hospitalized Hepatorenal Syndrome Patients Paris Charilaou1 · Kalpit Devani2 · Romela Petrosyan3 · Chakradhar Reddy2 · Nikolaos Pyrsopoulos4 Received: 28 October 2019 / Accepted: 4 February 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background It has been reported that transjugular intrahepatic portosystemic shunting (TIPS) might be utilized as a salvage option for hepatorenal syndrome (HRS), while randomized controlled trials are pending and real-world contemporary data on inpatient mortality is lacking. Methods We conducted an observational retrospective cohort study from the National Inpatient Sample from 2005 to 2014. We included all adult patients admitted with HRS and cirrhosis, using ICD 9-CM codes. We excluded cases with variceal bleeding, Budd–Chiari, end-stage renal disease, liver transplant and transfers to acute-care facilities. TIPS’ association with inpatient mortality was assessed using multivariable mixed-effects logistic regression, as well as exact-matching, thus mitigating for TIPS selection bias. The exact-matched analysis was repeated among TIPS-only versus dialysis-only patients. Results A total of 79,354 patients were included. Nine hundred eighteen (1.2%) underwent TIPS. Between TIPS and nonTIPS groups, mean age (58 years) and gender (65% males) were similar. Overall mortality was 18% in TIPS and 48% in dialysis-only cases (n = 10,379; 13.1%). Ninety six (10.5%) TIPS patients underwent dialysis. In-hospital mortality in TIPS patients was twice less likely than in non-TIPS patients (adjusted odds ratio [aOR] = 0.43, 95% CI 0.30–0.62; p
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