BACKGROUND/AIMS: Meta-analysis designed to provide evidence-based guidance on the effect of TIPS and paracentesis on mortality and encephalopathy in cirrhotic patients with refractory ascites. METHODS: Five randomized trials published between 1989 and 2005 were identified. RESULTS: The five trials involved 330 patients, and none included patients >76 years, with bilirubin >5-10 mg/dl or creatinine >3 mg/dl. Ascites recurrence was lower in the TIPS arm (RR 0.56; 95% CI 0.47-0.66). TIPS was associated with a greater risk of encephalopathy (RR 1.36; 95% CI 1.1-1.68) and severe encephalopathy (RR 1.72; 95% CI 1.14-2.58). TIPS did not affect mortality, as estimated by the RR (0.93; 95% CI 0.67-1.28, random effect model) and pooled hazard ratio (RR 1.09; 95% CI 0.84-1.88). Analysis of this outcome measure was limited by significant heterogeneity among trials. Liver-related mortality was homogenous and similar in both arms. Results were unaffected by excluding trials of lower quality or with a greater number of alcoholics. Meta-analysis of trials including patients with recidivant ascites revealed a lower mortality in the TIPS arm (RR 0.68; 95% CI 0.49-0.93). CONCLUSIONS: In patients with refractory ascites, a better control of ascites by TIPS does not translate into improved survival and worsens encephalopathy.
BACKGROUND/AIMS: Meta-analysis designed to provide evidence-based guidance on the effect of TIPS and paracentesis on mortality and encephalopathy in cirrhoticpatients with refractory ascites. METHODS: Five randomized trials published between 1989 and 2005 were identified. RESULTS: The five trials involved 330 patients, and none included patients >76 years, with bilirubin >5-10 mg/dl or creatinine >3 mg/dl. Ascites recurrence was lower in the TIPS arm (RR 0.56; 95% CI 0.47-0.66). TIPS was associated with a greater risk of encephalopathy (RR 1.36; 95% CI 1.1-1.68) and severe encephalopathy (RR 1.72; 95% CI 1.14-2.58). TIPS did not affect mortality, as estimated by the RR (0.93; 95% CI 0.67-1.28, random effect model) and pooled hazard ratio (RR 1.09; 95% CI 0.84-1.88). Analysis of this outcome measure was limited by significant heterogeneity among trials. Liver-related mortality was homogenous and similar in both arms. Results were unaffected by excluding trials of lower quality or with a greater number of alcoholics. Meta-analysis of trials including patients with recidivant ascites revealed a lower mortality in the TIPS arm (RR 0.68; 95% CI 0.49-0.93). CONCLUSIONS: In patients with refractory ascites, a better control of ascites by TIPS does not translate into improved survival and worsens encephalopathy.
Authors: Jennifer Guy; Ma Somsouk; Stephen Shiboski; Robert Kerlan; John M Inadomi; Scott W Biggins Journal: Clin Gastroenterol Hepatol Date: 2009-06-26 Impact factor: 11.382
Authors: Andrew S Allegretti; Xavier Vela Parada; Guillermo A Ortiz; Joshua Long; Scott Krinsky; Sophia Zhao; Bryan C Fuchs; Mozhdeh Sojoodi; Dongsheng Zhang; S Ananth Karumanchi; Sahir Kalim; Sagar U Nigwekar; Ravi I Thadhani; Samir M Parikh; Raymond T Chung Journal: Hepatology Date: 2019-01-04 Impact factor: 17.425