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The infection risk after transjugular intrahepatic portosystemic shunt: A multiple competing risk analysis from a tertiary care center

  • Author Footnotes
    1 These authors contributed equally to this work.
    Marta Colaneri
    Correspondence
    Corresponding author.
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Andrea Lombardi
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy

    Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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  • Marcello Maffezzoni
    Affiliations
    Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
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  • Margherita Sambo
    Affiliations
    Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
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  • Massimiliano Fabbiani
    Affiliations
    Infectious and Tropical Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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  • Pietro Quaretti
    Affiliations
    Diagnostic Radiology and General Interventional Radiology, IRCCS San Matteo, Pavia, Italy
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  • Erika Asperges
    Affiliations
    Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
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  • Lorenzo Moramarco
    Affiliations
    Diagnostic Radiology and General Interventional Radiology, IRCCS San Matteo, Pavia, Italy
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  • Paolo Sacchi
    Affiliations
    Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy
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  • Raffaele Bruno
    Affiliations
    Infectious Diseases I Unit, IRCCS San Matteo, Pavia, Italy and Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, V.le Golgi, 19, PV, 27100, Padiglione n. 42, Pavia, Italy

    Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Italy
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      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)
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