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Abstract：
OBJECTIVE: Transjugular intrahepatic portosystemic shunt (TIPS) is a catheter-based, minimally invasive procedure to reduce portal hypertension. The aim of the study was to investigate dysfunction and mortality after TIPS and to identify factors associated with these events.
METHODS: A retrospective analysis of 834 patients undergoing TIPS implantation in a single center from 1993-2018 was performed. Cumulative incidence curves were estimated, and frailty models were used to assess associations between potentially influential variables and time to dysfunction or death.
RESULTS: 1-, 2-, and 5-year mortality rates were 20.9% (confidence interval (CI) 17.7-24.1), 22.5% (CI 19.1-25.8), and 25.0% (CI: 21.1-28.8), 1-year, 2-year, and 5-year dysfunction rates were 28.4% (CI 24.6-32.3), 38.9% (CI 34.5-43.3), and 52.4% (CI 47.2-57.6). The use of covered stents is a protective factor regarding TIPS dysfunction (hazard ratio (HR) 0.47, CI 0.33-0.68) but does not play a major role in survival (HR 0.95, CI 0.58-1.56). Risk factors for mortality are rather TIPS in an emergency setting (HR 2.78, CI 1.19-6.50), a previous TIPS dysfunction (HR 2.43, CI 1.28-4.62), and an increased Freiburg score (HR 1.45, CI 0.93-2.28).
CONCLUSIONS: The use of covered stents is an important protective factor regarding TIPS dysfunction. Whereas previous TIPS dysfunction, emergency TIPS implantation, and an elevated Freiburg score are associated with increased mortality. Awareness of risk factors could contribute to a better selection of patients who may benefit from a TIPS procedure and improve clinical follow-up with regard to early detection of thrombosis/stenosis.
UNASSIGNED: The use of covered stents reduces the risk of dysfunction after transjugular intrahepatic portosystemic shunt (TIPS). TIPS dysfunction, emergency TIPS placement, and a high Freiburg score are linked to higher mortality rates in TIPS patients.
CONCLUSIONS: The risk of dysfunction is higher for uncovered stents compared to covered stents. Transjugular intrahepatic portosystemic shunt dysfunction increases the risk of instantaneous death after the intervention. A higher Freiburg score increases the rate of death after the intervention. Transjugular intrahepatic portosystemic shunt implantations in emergency settings reduce survival rates.
METHODS: A retrospective analysis of 834 patients undergoing TIPS implantation in a single center from 1993-2018 was performed. Cumulative incidence curves were estimated, and frailty models were used to assess associations between potentially influential variables and time to dysfunction or death.
RESULTS: 1-, 2-, and 5-year mortality rates were 20.9% (confidence interval (CI) 17.7-24.1), 22.5% (CI 19.1-25.8), and 25.0% (CI: 21.1-28.8), 1-year, 2-year, and 5-year dysfunction rates were 28.4% (CI 24.6-32.3), 38.9% (CI 34.5-43.3), and 52.4% (CI 47.2-57.6). The use of covered stents is a protective factor regarding TIPS dysfunction (hazard ratio (HR) 0.47, CI 0.33-0.68) but does not play a major role in survival (HR 0.95, CI 0.58-1.56). Risk factors for mortality are rather TIPS in an emergency setting (HR 2.78, CI 1.19-6.50), a previous TIPS dysfunction (HR 2.43, CI 1.28-4.62), and an increased Freiburg score (HR 1.45, CI 0.93-2.28).
CONCLUSIONS: The use of covered stents is an important protective factor regarding TIPS dysfunction. Whereas previous TIPS dysfunction, emergency TIPS implantation, and an elevated Freiburg score are associated with increased mortality. Awareness of risk factors could contribute to a better selection of patients who may benefit from a TIPS procedure and improve clinical follow-up with regard to early detection of thrombosis/stenosis.
UNASSIGNED: The use of covered stents reduces the risk of dysfunction after transjugular intrahepatic portosystemic shunt (TIPS). TIPS dysfunction, emergency TIPS placement, and a high Freiburg score are linked to higher mortality rates in TIPS patients.
CONCLUSIONS: The risk of dysfunction is higher for uncovered stents compared to covered stents. Transjugular intrahepatic portosystemic shunt dysfunction increases the risk of instantaneous death after the intervention. A higher Freiburg score increases the rate of death after the intervention. Transjugular intrahepatic portosystemic shunt implantations in emergency settings reduce survival rates.
摘要：
目的：经颈静脉肝内门体分流术（TIPS）是一种基于导管的，降低门静脉高压症的微创手术。该研究的目的是调查TIPS后的功能障碍和死亡率，并确定与这些事件相关的因素。
方法：对1993-2018年在单中心接受TIPS植入的834例患者进行回顾性分析。估计累积发病率曲线，和虚弱模型用于评估潜在影响变量与至功能障碍或死亡的时间之间的关联.
结果：1-，2-,5年死亡率为20.9%（置信区间（CI）17.7-24.1），22.5%（CI19.1-25.8），和25.0%（CI：21.1-28.8），1年,2年,5年功能障碍率为28.4%（CI24.6-32.3），38.9%（CI34.5-43.3），和52.4%（CI47.2-57.6）。使用覆膜支架是TIPS功能障碍的保护因素（风险比（HR）0.47，CI0.33-0.68），但对生存没有主要作用（HR0.95，CI0.58-1.56）。死亡的危险因素是紧急情况下的TIPS（HR2.78，CI1.19-6.50），先前的TIPS功能障碍(HR2.43，CI1.28-4.62)，弗莱堡评分增加（HR1.45，CI0.93-2.28）。
结论：使用覆膜支架是TIPS功能障碍的重要保护因素。而以前的TIPS功能障碍，紧急TIPS植入,弗莱堡评分升高与死亡率增加相关.对危险因素的认识可能有助于更好地选择可能从TIPS程序中受益的患者，并改善早期发现血栓形成/狭窄的临床随访。
■使用覆膜支架可降低经颈静脉肝内门体分流术（TIPS）后功能障碍的风险。TIPS功能障碍,紧急TIPS放置,高弗莱堡评分与TIPS患者的高死亡率相关。
结论：与覆盖支架相比，未覆盖支架的功能障碍风险更高。经颈静脉肝内门体分流功能障碍增加了干预后瞬时死亡的风险。较高的弗莱堡评分会增加干预后的死亡率。急诊经颈静脉肝内门体分流术植入降低生存率.
方法：对1993-2018年在单中心接受TIPS植入的834例患者进行回顾性分析。估计累积发病率曲线，和虚弱模型用于评估潜在影响变量与至功能障碍或死亡的时间之间的关联.
结果：1-，2-,5年死亡率为20.9%（置信区间（CI）17.7-24.1），22.5%（CI19.1-25.8），和25.0%（CI：21.1-28.8），1年,2年,5年功能障碍率为28.4%（CI24.6-32.3），38.9%（CI34.5-43.3），和52.4%（CI47.2-57.6）。使用覆膜支架是TIPS功能障碍的保护因素（风险比（HR）0.47，CI0.33-0.68），但对生存没有主要作用（HR0.95，CI0.58-1.56）。死亡的危险因素是紧急情况下的TIPS（HR2.78，CI1.19-6.50），先前的TIPS功能障碍(HR2.43，CI1.28-4.62)，弗莱堡评分增加（HR1.45，CI0.93-2.28）。
结论：使用覆膜支架是TIPS功能障碍的重要保护因素。而以前的TIPS功能障碍，紧急TIPS植入,弗莱堡评分升高与死亡率增加相关.对危险因素的认识可能有助于更好地选择可能从TIPS程序中受益的患者，并改善早期发现血栓形成/狭窄的临床随访。
■使用覆膜支架可降低经颈静脉肝内门体分流术（TIPS）后功能障碍的风险。TIPS功能障碍,紧急TIPS放置,高弗莱堡评分与TIPS患者的高死亡率相关。
结论：与覆盖支架相比，未覆盖支架的功能障碍风险更高。经颈静脉肝内门体分流功能障碍增加了干预后瞬时死亡的风险。较高的弗莱堡评分会增加干预后的死亡率。急诊经颈静脉肝内门体分流术植入降低生存率.
