Amine Benmassaoud1,2, Davide Roccarina1,2, Francesco Arico1,2, Gioacchino Leandro3, Becky Yu1,2, Felix Cheng1,2, Dominic Yu4, David Patch1,2, Emmanuel Tsochatzis1,2. 1. The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK. 2. UCL Institute for Liver and Digestive Health, University College of London, London, UK. 3. National Institute of Gastroenterology, S. De Bellis Research Hospital, Castellana Grotte, Italy. 4. Department of Radiology, Royal Free London NHS Trust, London, UK.
Abstract
INTRODUCTION: The impact of sarcopenia in patients undergoing transjugular intrahepatic portosystemic shunt (TIPSS) insertion for refractory ascites is unknown. METHODS: All adult patients who underwent TIPSS insertion for refractory ascites between 2010 and 2018 were included. Skeletal muscle index at L3 was used to determine sarcopenia status. RESULTS: One hundred seven patients were followed for 14.2 months. Sarcopenia was present in 57% of patients. No patient had history of pre-TIPSS hepatic encephalopathy (HE). De novo HE occurred in 30% of patients. On multivariate analysis, only platelet count and L3-SMI predicted de novo HE. On multivariate analysis, age and model for end-stage liver disease with sodium predicted mortality, whereas L3-SMI and sarcopenia did not. In patients with repeat imaging, L3-SMI improved significantly post-TIPSS compared with baseline. DISCUSSION: Sarcopenia should not be considered as a contraindication to TIPSS insertion in refractory ascites because it is not associated with de novo HE or increased mortality.
INTRODUCTION: The impact of sarcopenia in patients undergoing transjugular intrahepatic portosystemic shunt (TIPSS) insertion for refractory ascites is unknown. METHODS: All adult patients who underwent TIPSS insertion for refractory ascites between 2010 and 2018 were included. Skeletal muscle index at L3 was used to determine sarcopenia status. RESULTS: One hundred seven patients were followed for 14.2 months. Sarcopenia was present in 57% of patients. No patient had history of pre-TIPSS hepatic encephalopathy (HE). De novo HE occurred in 30% of patients. On multivariate analysis, only platelet count and L3-SMI predicted de novo HE. On multivariate analysis, age and model for end-stage liver disease with sodium predicted mortality, whereas L3-SMI and sarcopenia did not. In patients with repeat imaging, L3-SMI improved significantly post-TIPSS compared with baseline. DISCUSSION: Sarcopenia should not be considered as a contraindication to TIPSS insertion in refractory ascites because it is not associated with de novo HE or increased mortality.
Authors: Jennifer C Lai; Puneeta Tandon; William Bernal; Elliot B Tapper; Udeme Ekong; Srinivasan Dasarathy; Elizabeth J Carey Journal: Hepatology Date: 2021-09 Impact factor: 17.298