Analysis of the long-term prognosis of transjugular intrahepatic portosystemic shunt treatment for esophagogastric variceal hemorrhage concomitant with sarcopenia in cirrhotic patients
Objective To explore whether transjugular intrahepatic portosystemic shunt(TIPS)can improve the prognosis of esophagogastric variceal bleeding(EGVB)combined with sarcopenia in cirrhotic patients.Methods A retrospective cohort study was performed.A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected.Regular follow-up was performed for the long-term after treatment.The primary outcome was transplantation-free survival.The secondary endpoints were rebleeding and overt hepatic encephalopathy(OHE).The obtained data were statistically analyzed.The t-test and Wilcoxon rank-sum test were used to compare continuous variables between groups.The x2 test,or Fisher's exact probability test,was used to compare categorical variables between groups.Results The age of the included patients was 55.27±13.86 years,and 286 cases were male.There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia.The median follow-up period was 43 months.The two groups had no statistically significant difference in follow-up time.There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort(HR=1.31,95％CI:0.97-1.78,P=0.08).The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival(median survival:47.76 vs.52.45,x2=4.09;HR=1.55,95CI:1.01～2.38,P=0.04).There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia(HR=1.22,95％CI:0.78～1.88,P=0.39).Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination(patients without combined sarcopenia:median rebleeding time:39.48 vs.53.61,x2=18.68;R=2.47,95CI:1.67～3.65,P＜0.01;patients with sarcopenia:median rebleeding time:39.91 vs.50.68,x2=12.36;HR=2.20,95CI:1.42～3.40,P＜0.01).TIPS patients had an increased 1-year OHE incidence rate compared to the standard treatment group(sarcopenia patients:6.93％vs.16.67％,x2=3.87,P=0.049;patients without sarcopenia combination:2.19％vs.9.68％,x2=8.85,P=0.01).There was no statistically significant difference in the long-term OHE incidence rate between the two kinds of treatment groups(P＞0.05).Conclusion TIPS can significantly prolong transplant-free survival compared to standard treatment as a secondary prevention of EGVB concomitant with sarcopenia in patients with cirrhosis.However,its advantage is not prominent for patients with cirrhosis in EGVB without sarcopenia.
万方数据
维普
