Abstract
Background
Infections following transjugular intrahepatic portosystemic shunt (TIPS) placement
have been poorly described. We aim to investigate the rate and the potential predictors
of infections occurring after TIPS placement.
Methods
Single center, retrospective, observational study. All patients who had undergone
TIPS placement in the last 10 years with a minimum 1-year FU, were considered. Multiple
competing risk analyses were performed to identify infection risk factors and a multivariable
Cox proportional-hazard regression model to evaluate the predictors of death.
Results
Forty-nine patients were considered. Among these, 23 (46%) developed at least 1 infection
during the FU, at a median time of 237.7 days (IQR 151.5) from the TIPS placement.
We did not find any predictor of infection, while MELD score and cancer were associated
with death (p = .04; HR 1.14; CI 1.00- 1.30).
Conclusion
We found a high rate of all-type infections during the FU times. However, most of
these infections occurred as late-onset infections and were caused by Gram-positive
microorganisms. Thus, TIPS procedure itself does not seem to be burdened with high
infectious perioperative risk.
Keywords
Abbreviations:
TIPS (transjugular intrahepatic portosystemic shunt), PH (portal hypertension.), HE (hepatic encephalopathy), FU (follow-up), HVPG (hepatic venous pressure gradient), BL (baseline), HCV (hepatitis C virus), HBsAg (hepatitis B virus surface antigen), HIV (human immunodeficiency virus), AST (aspartate aminotransferase), ALT (alanine aminotransferase), CRP (C-reactive protein), CTP (child-Turcotte-Pugh), SBP (spontaneous bacterial peritonitis), UTI (urinary tract infection), BTI (biliary tract infection), MDR (multi-drug resistant), NAFLD (non-alcoholic fatty liver disease), SHR (subdistribution hazard ratios)To read this article in full you will need to make a payment
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References
- Comprehensive review of TIPS technical complications and how to avoid them.AJR Am J Roentgenol. 2011; 196: 675-685
- Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) according to its severity and temporal grading classification.Radiol Med. 2017; 122: 713-721
- Relationship between pre-TIPS liver perfusion by the portal vein and the incidence of post-TIPS chronic hepatic encephalopathy.Am J Gastroenterol. 2001; 96: 1205-1209
- New case of endotipsitis: urgent need for clinical practice guidelines.Eurasian J Med. 2017; 49: 214-216
- Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis.Hepatology. 2002; 35: 140-148
- Risk factors and prevention of early infection after implantation or revision of transjugular intrahepatic portosystemic shunts: results of a randomized study.Dig Dis Sci. 1998; 42: 1708-1713
- Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a society of interventional radiology practice parameter update endorsed by the cardiovascular and interventional radiological society of Europe and the Canadian association for interventional radiology.J Vasc Interv Radiol. 2018; 29 (.e2): 1483-1501
- Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.Clin Microbiol Infect. 2012; 18: 268-281
- The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults.Clin Infect Dis. 1997; 24: 584-602
- A proportional hazards model for the subdistribution of a competing risk.J Am Stat Assoc. 1999; 94: 496-509
- Infection of transjugular intrahepatic portosystemic shunt devices: three cases and a review of the literature.Clin Infect Dis. 2003; 36: 407-412
- Sustained bacteremia associated with transjugular intrahepatic portosystemic shunt (TIPS).Clin Infect Dis. 2000; 30: 384-386
- Risk factors contributing to early infection following transjugular intrahepatic portosystemic shunt in perioperative period.Ann Hepatol. 2016; 15: 745-751
- Endotipsitis: a case report with a literature review on an emerging prosthetic related infection.World J Hepatol. 2015; 7: 710
- Bacteremia and "Endotipsitis" following transjugular intrahepatic portosystemic shunting.World J Hepatol. 2011; 3: 130-136
- Risk factors and prevention of early infection after implantation or revision of transjugular intrahepatic portosystemic shunts (Results of a Randomized Study).Dig Dis Sci. 1998; 43: 1708-1713
- Endotipsitis: a rare case of endovascular infection with ESBL Klebsiella pneumoniae.BMJ Case Rep. 2020; 13e233972
- Fungal endotipsitis: a case report and literature review.J Dig Dis. 2017; 18: 237-240
- MELD accurately predicts mortality in patients with alcoholic hepatitis.Hepatology. 2005; 41: 353-358
- Increased risk for malignant neoplasms among patients with cirrhosis.Clin Gastroenterol Hepatol. 2011; 9: 168-174
- New Case of endotipsitis: urgent need for clinical practice guidelines.Eurasian J Med. 2017; 49: 214-216
Article info
Publication history
Published online: June 10, 2022
Accepted:
May 13,
2022
Received:
January 9,
2022
Dear Editor: Maurizio VecchiIdentification
Copyright
© 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
