| 【Background】1.Ascites is one of the most common complications of cirrhotic patient,and approximately 60% of patients with cirrhosis will develop ascites within 10 years after diagnosis of the disease.Each year approximately 5-10% of patients develop refractory ascites during follow-up,since then the median survival time only 6 months.In the treatment guideline TIPS was recommended as an alternative therapy after the therapy failure of LVP+A.Recently,a RCT study demonstrated that compared with LVP+A,TIPS can improved liver transplantation free survival without increase the risk of HE.The study included selected patients with recurrent ascites,and concluded that TIPS as the first-line treatment for such patients.However,there are no selective criterions to choose the optimal cirrhotic patients with refractory to undergo TIPS in China,and there are no international accepted criterions.In our retrospective study we aim to investigate the optimal predictive factors of post-TIPS survival for refractory ascites with cirrhosis.2.Cirrhotic patients with RA have high risk to develop HRS,and then prognosis was deteriorated.Cystatin C has been suggested as a sensitive marker of renal function,independent of sex or muscle mass.Its’ value in Patients with cirrhosis has beendemonstrated.However,the role of Cystatin C in post-TIPS survival in cirrhotic patients with RA was unknown.【Aims】1.To explore the predictive value of Child-Pugh score,MELD score,ALBI score and a simple model in RA patients with cirrhosis in our center.2.This study aim to investigate the value of Cystatin C for the post-TIPS outcomes in cirrhotic patients with refractory ascites.【Methods】1.From January 2005 to January 2016,119 consecutive cirrhotic patients with RA treated by TIPS in our center were followed until last clinical evaluation or death.Compared the predictive value of post-TIPS survival among Child-Pugh score,MELD score and the simple model Using AUC.2.From January 2010 to January 2016,92 consecutive patients with cirrhosis treated with TIPS for refractory ascite were followed until last clinical evaluation or death.Analysis the outcomes of TIPS,included survival,post-TIPS HE,ascites and other portal hypertension complications.【Results】1.119 consecutive patients were included in our study,among them 79 patients were men(63.9%),mean age 52.8 years(SD 11.9 years),median survival was 18.3months.A multivariate analysis firmed older(HR=1.029,95%CI 1.010-1.049,P=0.003),high bilirubin(HR=1.015,95%CI 1.004-1.027,P=0.01),Low albumin(HR=0.911,95%CI 0.862-0.962,P=0.001).For the predictive of 3-months survival,the AUC of Child-Pugh score,MELD score and simple model were 0.738(95%CI 0.631-0.846,P=0.001),0.662(95%CI 0.528-0.796,P=0.023)and 0.557(95%CI 0.423-0.690,P=0.426)respectively.2.92 consecutive patients were enrolled,57 men,mean age 53.2 years,viral hepatitis were the majority cause of cirrhosis(67.8%),and 65.2% were Child-Pugh C.The median survival was 19 months and maximum following period was 74 months.Cystatin C(HR=1.759,95%CI 1.218-2.541,P=0.003)and ALB(HR=0.888,95%CI0.831-0.948,P<0.001)were the independent predictive factors for post-TIPS survival.Cys C was the independent predictive factor for post-TIPS HE and relieved of ascites.Patients with Cys C < 1.435mg/L and ALB > 28g/L with relatively better survival(P=0.011,log-rank).【Conclusions】1.Child-Pugh and MELD score can predict the risk of mortality of 3 months after TIPS for cirrhotic patients with RA.2.Cystatin C combined with albumin was a potential predict model for post-TIPS survival.Cystatin C was the independent predictive factor for post-TIPS HE and relieved of ascites. |
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