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Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT‐based surveillance
Author(s) -
Artru Florent,
Miquet Xavier,
Azahaf Mustapha,
Labreuche Julien,
Ntandja Wandji Line Carolle,
Sergent Géraldine,
Nobécourt Amélie,
Toumelin Pierre,
Lassailly Guillaume,
Dharancy Sébastien,
Ernst Olivier,
Mathurin Philippe,
Louvet Alexandre
Publication year - 2020
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.16080
Subject(s) - medicine , portal hypertension , cirrhosis , sarcopenia , liver disease , gastroenterology , retrospective cohort study , body surface area , nuclear medicine , surgery
Summary Background Body composition may be modified after improvement of portal hypertension (PHT) by transjugular intrahepatic portosystemic shunt (TIPSS) insertion. Aims To evaluate changes in body composition following TIPSS placement, their relationship with radiological TIPSS patency and function, and the predictive value of these parameters Methods We retrospectively included 179 patients with cirrhosis who underwent TIPSS placement in our centre for severe PHT from 2011 to 2017. CT scan‐based surveillance was performed at baseline, 1‐3 (M1‐M3) and 6 months (M6). Results The median model for end‐stage liver disease (MELD) score was 11.4 (8.8‐15.1) and Child‐Pugh score 8 (7‐9). Only the MELD score (HR 1.14, 95% CI 1.08‐1.20) and sarcopenia assessed by transversal right psoas muscle thickness at the umbilical level/height (TPMPT/height) (HR 0.86, 95% CI 0.79‐0.96) were independently associated with 6‐month mortality on multivariate analysis. After TIPSS insertion, TPMT/height increased from 19 mm/m (baseline) to 19.6 mm/m (M1‐M3, P = 0.004) and 21.1 mm/m (M6, P < 0.0001). The improvement and its extent were dependent on the radiological patency and dysfunction of TIPSS. Subcutaneous fat surface (SCFS) increased from 183.4 to 193 cm 2 ( P < 0.0001) and 229.8 cm 2 ( P < 0.0001), respectively. We observed a decrease in visceral fat surface (VFS) between baseline and M1‐M3 (163.5‐140.5 cm 2 [ P < 0.0001]), but not between M1‐M3 and M6 (140.5‐141.2 cm 2 [ P = 0.9]). SCFS and VFS did not seem to be modified by radiological TIPSS patency and dysfunction. Conclusions Sarcopenia is independently associated with 6‐month outcome and improves after TIPSS placement, together with an inverse evolution of subcutaneous and visceral fat. TIPSS not only treats PHT but also improves body composition.