Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model
Corresponding Author
Francesco Vizzutti
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Correspondence
Francesco Vizzutti, Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 85, Florence, I-50134, Italy.
Email: [email protected]
Filippo Schepis, Division of Gastroenterology University of Modena & Reggio Emilia, Via del Pozzo 71, Modena, I-41100, Italy.
Email: [email protected]
Search for more papers by this authorCiro Celsa
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Department of Surgical, Oncological, and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
Search for more papers by this authorVincenza Calvaruso
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorMarco Enea
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorSalvatore Battaglia
Department of Economics, Business, and Statistics (SEAS), University of Palermo, Palermo, Italy
Search for more papers by this authorLaura Turco
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
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
Search for more papers by this authorMarco Senzolo
Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
Search for more papers by this authorSilvia Nardelli
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorRoberto Miraglia
Radiology Unit, Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
Search for more papers by this authorDavide Roccarina
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorClaudia Campani
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorDario Saltini
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorCristian Caporali
Radiology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorFederica Indulti
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorStefano Gitto
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorAlberto Zanetto
Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
Search for more papers by this authorGabriele Di Maria
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorMarcello Bianchini
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorMaddalena Pecchini
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorSilvia Aspite
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorChiara Di Bonaventura
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorMichele Citone
Department of Radiology, Interventional Radiology Unit, Careggi Hospital, Florence, Italy
Search for more papers by this authorTomas Guasconi
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorFabrizio Di Benedetto
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorUmberto Arena
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorFabrizio Fanelli
Department of Radiology, Interventional Radiology Unit, Careggi Hospital, Florence, Italy
Search for more papers by this authorLuigi Maruzzelli
Radiology Unit, Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
Search for more papers by this authorOliviero Riggio
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorPatrizia Burra
Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
Search for more papers by this authorAntonio Colecchia
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorErica Villa
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorFabio Marra
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Center for Research, High Education and Transfer DENOThe, University of Florence, Florence, Italy
Search for more papers by this authorCalogero Cammà
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorCorresponding Author
Filippo Schepis
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Correspondence
Francesco Vizzutti, Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 85, Florence, I-50134, Italy.
Email: [email protected]
Filippo Schepis, Division of Gastroenterology University of Modena & Reggio Emilia, Via del Pozzo 71, Modena, I-41100, Italy.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Francesco Vizzutti
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Correspondence
Francesco Vizzutti, Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 85, Florence, I-50134, Italy.
Email: [email protected]
Filippo Schepis, Division of Gastroenterology University of Modena & Reggio Emilia, Via del Pozzo 71, Modena, I-41100, Italy.
Email: [email protected]
Search for more papers by this authorCiro Celsa
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Department of Surgical, Oncological, and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
Search for more papers by this authorVincenza Calvaruso
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorMarco Enea
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorSalvatore Battaglia
Department of Economics, Business, and Statistics (SEAS), University of Palermo, Palermo, Italy
Search for more papers by this authorLaura Turco
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
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
Search for more papers by this authorMarco Senzolo
Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
Search for more papers by this authorSilvia Nardelli
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorRoberto Miraglia
Radiology Unit, Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
Search for more papers by this authorDavide Roccarina
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorClaudia Campani
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorDario Saltini
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorCristian Caporali
Radiology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorFederica Indulti
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorStefano Gitto
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorAlberto Zanetto
Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
Search for more papers by this authorGabriele Di Maria
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorMarcello Bianchini
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorMaddalena Pecchini
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorSilvia Aspite
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorChiara Di Bonaventura
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorMichele Citone
Department of Radiology, Interventional Radiology Unit, Careggi Hospital, Florence, Italy
Search for more papers by this authorTomas Guasconi
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorFabrizio Di Benedetto
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorUmberto Arena
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorFabrizio Fanelli
Department of Radiology, Interventional Radiology Unit, Careggi Hospital, Florence, Italy
Search for more papers by this authorLuigi Maruzzelli
Radiology Unit, Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
Search for more papers by this authorOliviero Riggio
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
Search for more papers by this authorPatrizia Burra
Multivisceral Transplant Unit-Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
Search for more papers by this authorAntonio Colecchia
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorErica Villa
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Search for more papers by this authorFabio Marra
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Center for Research, High Education and Transfer DENOThe, University of Florence, Florence, Italy
Search for more papers by this authorCalogero Cammà
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, Gastroenterology and Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
Search for more papers by this authorCorresponding Author
Filippo Schepis
Division of Gastroenterology, Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy
Correspondence
Francesco Vizzutti, Department of Experimental and Clinical Medicine, University of Florence, Viale Morgagni 85, Florence, I-50134, Italy.
Email: [email protected]
Filippo Schepis, Division of Gastroenterology University of Modena & Reggio Emilia, Via del Pozzo 71, Modena, I-41100, Italy.
Email: [email protected]
Search for more papers by this authorFrancesco Vizzutti and Ciro Celsa shared first authorship.
Calogero Cammà and Filippo Schepis shared senior authorship.
Abstract
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.
CONFLICT OF INTEREST
Dr. Vizzutti, Dr. Schepis, Dr. Riggio and Dr. Fanelli have received lecture fees from Gore. Dr. Schepis has also received grant support from Gore. Dr. Cammà is on the speakers' bureau for Eisai, Ipsen, AstraZeneca, and Roche. Dr. Celsa is on the speakers’ bureau for Eisai, Merck Sharp & Dohme, and Ipsen. Dr. Burra is on the speakers' bureau for Biotest, Kedrion, and Sandoz.
Supporting Information
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| hep32704-sup-0001-supplementary .docxWord 2007 document , 574.4 KB |
APPENDIX S1 Supporting information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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