Abstract：
OBJECTIVE: The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus extrahepatic collateral embolisation (TIPS+E) in reducing rebleeding and hepatic encephalopathy (HE) post-TIPS was recently reported in a meta-analysis, but further validation is essential. This study aims to confirm the effectiveness of TIPS+E using real-world data.
METHODS: The multicentre retrospective cohort included 2077 patients with cirrhosis who underwent TIPS±E (TIPS: 631, TIPS+E: 1446) between January 2010 and December 2022. Regression and propensity score matching (PSM) were used to adjust for baseline characteristic differences. After PSM, clinical outcomes, including rebleeding, HE, survival and further decompensation (FDC), were analysed. Baseline data from all patients contributed to the construction of prognostic models.
RESULTS: After PSM, 1136 matched patients (TIPS+E: TIPS=568:568) were included. TIPS+E demonstrated a significant reduction in rebleeding (HR 0.77; 95% CI 0.59 to 0.99; p=0.04), HE (HR 0.82; 95% CI 0.68 to 0.99; p=0.04) and FDC (HR 0.85; 95% CI 0.73 to 0.99; p=0.04), comparing to TIPS. Significantly, TIPS+E also reduced rebleeding, HE and FDC in subgroup of using 8 mm diameter stents and embolising of gastric varices+spontaneous portosystemic shunts (GV+SPSS). However, there were no differences in overall or subgroup survival analysis. Additionally, the random forest models showed higher accuracy and AUROC comparing to other models. Controlling post-TIPS portal pressure gradient (pPPG) within 7 mm HgCONCLUSIONS: Our real-world data validation confirms the high efficacy of TIPS+E in reducing rebleeding and HE, particularly when using 8 mm diameter stents, embolising GV+SPSS and maintaining an optimal pPPG.
METHODS: The multicentre retrospective cohort included 2077 patients with cirrhosis who underwent TIPS±E (TIPS: 631, TIPS+E: 1446) between January 2010 and December 2022. Regression and propensity score matching (PSM) were used to adjust for baseline characteristic differences. After PSM, clinical outcomes, including rebleeding, HE, survival and further decompensation (FDC), were analysed. Baseline data from all patients contributed to the construction of prognostic models.
RESULTS: After PSM, 1136 matched patients (TIPS+E: TIPS=568:568) were included. TIPS+E demonstrated a significant reduction in rebleeding (HR 0.77; 95% CI 0.59 to 0.99; p=0.04), HE (HR 0.82; 95% CI 0.68 to 0.99; p=0.04) and FDC (HR 0.85; 95% CI 0.73 to 0.99; p=0.04), comparing to TIPS. Significantly, TIPS+E also reduced rebleeding, HE and FDC in subgroup of using 8 mm diameter stents and embolising of gastric varices+spontaneous portosystemic shunts (GV+SPSS). However, there were no differences in overall or subgroup survival analysis. Additionally, the random forest models showed higher accuracy and AUROC comparing to other models. Controlling post-TIPS portal pressure gradient (pPPG) within 7 mm Hg
摘要：
目的：最近一项荟萃分析报道了经颈静脉肝内门体分流术（TIPS）加肝外侧支栓塞术（TIPS+E）减少TIPS后再出血和肝性脑病（HE）的疗效，但进一步的验证是必要的。本研究旨在使用真实世界数据确认TIPS+E的有效性。
方法：多中心回顾性队列包括2010年1月至2022年12月期间接受TIPS±E（TIPS：631，TIPS+E：1446）的2077例肝硬化患者。使用回归和倾向评分匹配(PSM)来调整基线特征差异。PSM之后,临床结果，包括再出血,他,生存和进一步失代偿（FDC），进行了分析。来自所有患者的基线数据有助于构建预后模型。
结果：PSM后，纳入1136名匹配患者(TIPS+E:TIPS=568:568)。TIPS+E显示再出血显著减少(HR0.77;95%CI0.59至0.99;p=0.04),HE（HR0.82；95%CI0.68至0.99；p=0.04）和FDC（HR0.85；95%CI0.73至0.99；p=0.04），比较TIPS。重要的是,TIPS+E也减少了再出血，HE和FDC在使用8mm直径支架和栓塞胃静脉曲张+自发性门体分流（GV+SPSS）的亚组中。然而,总体或亚组生存分析无差异.此外,与其他模型相比，随机森林模型显示出更高的准确性和AUROC。将TIPS术后门静脉压力梯度(pPPG)控制在7mmHg结论：我们的真实数据验证证实了TIPS+E在减少再出血和HE方面的高疗效，特别是当使用8毫米直径的支架时，栓塞GV+SPSS并维持最佳pPPG。
方法：多中心回顾性队列包括2010年1月至2022年12月期间接受TIPS±E（TIPS：631，TIPS+E：1446）的2077例肝硬化患者。使用回归和倾向评分匹配(PSM)来调整基线特征差异。PSM之后,临床结果，包括再出血,他,生存和进一步失代偿（FDC），进行了分析。来自所有患者的基线数据有助于构建预后模型。
结果：PSM后，纳入1136名匹配患者(TIPS+E:TIPS=568:568)。TIPS+E显示再出血显著减少(HR0.77;95%CI0.59至0.99;p=0.04),HE（HR0.82；95%CI0.68至0.99；p=0.04）和FDC（HR0.85；95%CI0.73至0.99；p=0.04），比较TIPS。重要的是,TIPS+E也减少了再出血，HE和FDC在使用8mm直径支架和栓塞胃静脉曲张+自发性门体分流（GV+SPSS）的亚组中。然而,总体或亚组生存分析无差异.此外,与其他模型相比，随机森林模型显示出更高的准确性和AUROC。将TIPS术后门静脉压力梯度(pPPG)控制在7mmHg
