Older age is associated with increased early mortality after transjugular intrahepatic portosystemic shunt

Nael Saad; Mary Katherine Rude; Michael Darcy; Jacob B Hanin; Ashley Wentworth; Kevin M Korenblat

doi:10.5604/16652681.1193716

Older age is associated with increased early mortality after transjugular intrahepatic portosystemic shunt

Ann Hepatol. 2016 Mar-Apr;15(2):215-221. doi: 10.5604/16652681.1193716.

Authors

Nael Saad¹, Mary Katherine Rude², Michael Darcy¹, Jacob B Hanin³, Ashley Wentworth⁴, Kevin M Korenblat⁵

Affiliations

¹ Vascular and Interventional Radiology and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO USA.
² Hepatology Section, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO USA.
³ Hepatology Section, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA.
⁴ Vascular and Interventional Radiology and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO USA; University Clinics Case Medical Center, Cleveland, OH USA.
⁵ Hepatology Section, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO USA. Electronic address: kkorenbl@dom.wustl.edu.

PMID: 31196403
DOI: 10.5604/16652681.1193716

Abstract

Introduction & aim: The role of age as a predictor of mortality after transjugular intra hepatic portosystemic shunt (TIPS) is controversial. Age has been found to be an important predictor of post-TIPS mortality in some, but not all, studies and is not a component of the MELD score. The purpose of this study was to compare the 90-day survival of subjects with cirrhosis age ≥ 70 years with younger subjects undergoing TIPS.

Material and methods: A database of adult with cirrhosis undergoing TIPS from 2003-2011 was analyzed. The primary endpoint was survival 90-days post-TIPS. Survival was analyzed by the Kaplan-Meier method and proportional hazard modeling.

Results: 539 subjects met study criteria. 474 (88%) were between the ages of 24-69 and 65 (12%) were age 70-89 years. The groups were similar with respect to the indication for TIPS, mean MELD score and distribution of MELD score. Survival 90-days post-TIPS was 60% in the older cohort compared with 85% in the younger cohort (p < 0.001). Proportional hazards modeling controlled for comorbidities identified age ≥ 70 and MELD score as predictors of early post-TIPS survival. The hazard ratio associated with age increased monotonically, became significant at age ≥ 70 years (HR 3.22; 95% CI 1.81-5.74; p < 0.001) and exceeded the effect of MELD on survival.

Conclusions: Age ≥ 70 was associated with reduced survival within 90 days following TIPS. The findings from this study indicate that age is a relevant consideration in assessing the early mortality risk of TIPS.

Keywords: Cirrhosis; Elderly; MELD; Portal hypertension; Survival.