Please use this identifier to cite or link to this item: https://accedacris.ulpgc.es/handle/10553/135912
Title: Massive spontaneous portosystemic shunt is a solid, easily identifiable prognostic factor in patients with cirrhosis
Authors: García-Villarreal, Luis
Ortega-Quevedo, Vanesa
Pérez Aguado, Guillermo 
Saavedra Santana, Pedro 
Quiñones, Ildefonso
Chang, Woo Rym
Hernández-Socorro, Carmen R.
Cabrera Cabrera,Juan 
UNESCO Clasification: 32 Ciencias médicas
3205 Medicina interna
Keywords: Chronic portosystemic encephalopathy
Cirrhosis
Portosystemic shunts
Sonography
Survival
Issue Date: 2023
Journal: European Journal of Gastroenterology and Hepatology 
Abstract: Objectives Spontaneous portosystemic shunts (SPSSs) are associated with complications and death in cirrhosis. We evaluated chronic portosystemic encephalopathy (CPSE) and survival in cirrhotic patients with massive (>10 mm diameter) SPSS (MSPSS). Methods We have retrospectively compared 77 cirrhotic patients with MSPSS and 77 paired-matched patients without SPSS. Results More patients with MSPSS presented with CPSE (40.3% vs. 20.8%, P = 0.010) or died (33.8% vs. 18.2%, P = 0.039). Model for Endstage Liver Disease (MELD) score [hazard ratio (HR) 1.146, 95% confidence interval (CI) 1.099-1.195], follow-up (FU) ascites (HR 5.128, 95% CI 2.396-10.973) and age (HR 1.048, 95% CI 1.017-1.080) were associated with CPSE; and MELD score (HR 1.082, 95% CI 1.035-1.131), FU renal failure (HR 9.319, 95% CI 3.595-24.158), and FU ascites (HR 4.320, 95% CI 1.615-11.555) were associated with death. Liver function worsened faster in the MSPSS group. Among patients with better liver function (MELD < 11.5), MSPSS patients presented worse survival (P = 0.048, Breslow test). Comparing patients by the Child-Pugh group, we did not find differences in survival; in patients from Child-Pugh group B + C, the MSPSS group presented less time free of CPSE (P < 0.05, log-rank test). Patients with splenorenal MSPSS presented better survival (P = 0.04, log-rank test), and patients with umbilical MSPSS had shorter time free of CPSE (P < 0.016, log-rank test). Conclusion MSPSS increased CPSE and death risks during long FU. Even with better liver function (MELD < 11.5), MSPSS was associated with lower survival. Splenorenal MSPSS presented better survival and the umbilical type was associated with shorter time free of CPSE.
URI: https://accedacris.ulpgc.es/handle/10553/135912
ISSN: 0954-691X
DOI: 10.1097/MEG.0000000000002569
Source: European Journal of Gastroenterology and Hepatology [eISSN 0954-691x], v. 35(7), pp. 769-776 (julio 2023)
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