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Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data

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Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding : a Meta-analysis of Individual Patient Data. / Nicoară-Farcău, Oana; Han, Guohong; Rudler, Marika; Angrisani, Debora; Monescillo, Alberto; Torres, Ferran; Casanovas, Georgina; Bosch, Jaime; Lv, Yong; Thabut, Dominique; Fan, Daiming; Hernández-Gea, Virginia; García-Pagán, Juan Carlos; preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups.

In: Gastroenterology, Vol. 160, No. 1, 01.2021, p. 193-205.e10.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Nicoară-Farcău, O, Han, G, Rudler, M, Angrisani, D, Monescillo, A, Torres, F, Casanovas, G, Bosch, J, Lv, Y, Thabut, D, Fan, D, Hernández-Gea, V, García-Pagán, JC & preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups 2021, 'Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data', Gastroenterology, vol. 160, no. 1, pp. 193-205.e10. https://doi.org/10.1053/j.gastro.2020.09.026

APA

Nicoară-Farcău, O., Han, G., Rudler, M., Angrisani, D., Monescillo, A., Torres, F., Casanovas, G., Bosch, J., Lv, Y., Thabut, D., Fan, D., Hernández-Gea, V., García-Pagán, J. C., & preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups (2021). Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data. Gastroenterology, 160(1), 193-205.e10. https://doi.org/10.1053/j.gastro.2020.09.026

CBE

Nicoară-Farcău O, Han G, Rudler M, Angrisani D, Monescillo A, Torres F, Casanovas G, Bosch J, Lv Y, Thabut D, Fan D, Hernández-Gea V, García-Pagán JC, preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups. 2021. Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data. Gastroenterology. 160(1):193-205.e10. https://doi.org/10.1053/j.gastro.2020.09.026

MLA

Vancouver

Author

Nicoară-Farcău, Oana ; Han, Guohong ; Rudler, Marika ; Angrisani, Debora ; Monescillo, Alberto ; Torres, Ferran ; Casanovas, Georgina ; Bosch, Jaime ; Lv, Yong ; Thabut, Dominique ; Fan, Daiming ; Hernández-Gea, Virginia ; García-Pagán, Juan Carlos ; preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups. / Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding : a Meta-analysis of Individual Patient Data. In: Gastroenterology. 2021 ; Vol. 160, No. 1. pp. 193-205.e10.

Bibtex

@article{57f117b7ca0a463e8d06d57e1a6a1c7d,
title = "Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data",
abstract = "BACKGROUND & AIMS: Compared with drugs plus endoscopy, placement of transjugular portosystemic shunt within 72 hours of admission to the hospital (early or preventive transjugular intrahepatic portosystemic shunt [TIPS], also called preemptive TIPS) increases the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survive for 1 year. However, the benefit of preemptive TIPS is less clear for patients with a Child-Pugh score of B and active bleeding (CP-B+AB). We performed an individual data meta-analysis to assess the efficacy of preemptive TIPS in these patients and identify factors associated with reduced survival of patients receiving preemptive TIPS.METHODS: We searched publication databases for randomized controlled trials and observational studies comparing the effects of preemptive TIPS versus endoscopy plus nonselective beta-blockers in the specific population of high-risk patients with cirrhosis and acute variceal bleeding (CP-B+AB or Child-Pugh C, below 14 points), through December 31, 2019. We performed a meta-analysis of data from 7 studies (3 randomized controlled trials and 4 observational studies), comprising 1327 patients (310 received preemptive TIPS and 1017 received drugs plus endoscopy). We built adjusted models to evaluate risk using propensity score for baseline covariates. Multivariate Cox regression models were used to assess the factors associated with survival time. The primary endpoint was effects of preemptive TIPS versus drugs plus endoscopy on 1-year survival in the overall population as well as CP-B+AB and Child-Pugh C patients.RESULTS: Overall, preemptive TIPS significantly increased the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survived for 1 year, compared with drugs plus endoscopy (hazard ratio [HR] 0.443; 95% CI 0.323-0.607; P < .001). This effect was observed in CP-B+AB patients (HR 0.524; 95% CI 0.307-0.896; P = .018) and in patients with Child-Pugh C scores below 14 points (HR 0.374; 95% CI 0.253-0.553; P < .001). Preemptive TIPS significantly improved control of bleeding and ascites without increasing risk of hepatic encephalopathy in Child-Pugh C and CP-B+AB patients, compared with drugs plus endoscopy. Cox analysis of patients who received preemptive TIPS showed that patients could be classified into 3 categories for risk of death, based on age, serum level of creatinine, and Child-Pugh score. In each of these risk categories, preemptive TIPS increased the proportion of patients who survived for 1 year, compared with drugs plus endoscopy.CONCLUSIONS: In a meta-analysis of data from 1327 patients with cirrhosis, acute variceal bleeding, and Child-Pugh score between 10 and 13 points or CP-B+AB, preemptive TIPS increased the proportion who survived for 1 year, in both subgroups separately, compared with drugs plus endoscopy.",
keywords = "AVB, HE, Liver Disease, Treatment",
author = "Oana Nicoar{\u a}-Farc{\u a}u and Guohong Han and Marika Rudler and Debora Angrisani and Alberto Monescillo and Ferran Torres and Georgina Casanovas and Jaime Bosch and Yong Lv and Dominique Thabut and Daiming Fan and Virginia Hern{\'a}ndez-Gea and Garc{\'i}a-Pag{\'a}n, {Juan Carlos} and {preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups} and Henning Gr{\o}nb{\ae}k",
note = "Copyright {\textcopyright} 2020 AGA Institute. All rights reserved.",
year = "2021",
month = jan,
doi = "10.1053/j.gastro.2020.09.026",
language = "English",
volume = "160",
pages = "193--205.e10",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "Elsevier",
number = "1",

}

RIS

TY - JOUR

T1 - Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding

T2 - a Meta-analysis of Individual Patient Data

AU - Nicoară-Farcău, Oana

AU - Han, Guohong

AU - Rudler, Marika

AU - Angrisani, Debora

AU - Monescillo, Alberto

AU - Torres, Ferran

AU - Casanovas, Georgina

AU - Bosch, Jaime

AU - Lv, Yong

AU - Thabut, Dominique

AU - Fan, Daiming

AU - Hernández-Gea, Virginia

AU - García-Pagán, Juan Carlos

AU - preemptive TIPS individual data metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups

AU - Grønbæk, Henning

N1 - Copyright © 2020 AGA Institute. All rights reserved.

PY - 2021/1

Y1 - 2021/1

N2 - BACKGROUND & AIMS: Compared with drugs plus endoscopy, placement of transjugular portosystemic shunt within 72 hours of admission to the hospital (early or preventive transjugular intrahepatic portosystemic shunt [TIPS], also called preemptive TIPS) increases the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survive for 1 year. However, the benefit of preemptive TIPS is less clear for patients with a Child-Pugh score of B and active bleeding (CP-B+AB). We performed an individual data meta-analysis to assess the efficacy of preemptive TIPS in these patients and identify factors associated with reduced survival of patients receiving preemptive TIPS.METHODS: We searched publication databases for randomized controlled trials and observational studies comparing the effects of preemptive TIPS versus endoscopy plus nonselective beta-blockers in the specific population of high-risk patients with cirrhosis and acute variceal bleeding (CP-B+AB or Child-Pugh C, below 14 points), through December 31, 2019. We performed a meta-analysis of data from 7 studies (3 randomized controlled trials and 4 observational studies), comprising 1327 patients (310 received preemptive TIPS and 1017 received drugs plus endoscopy). We built adjusted models to evaluate risk using propensity score for baseline covariates. Multivariate Cox regression models were used to assess the factors associated with survival time. The primary endpoint was effects of preemptive TIPS versus drugs plus endoscopy on 1-year survival in the overall population as well as CP-B+AB and Child-Pugh C patients.RESULTS: Overall, preemptive TIPS significantly increased the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survived for 1 year, compared with drugs plus endoscopy (hazard ratio [HR] 0.443; 95% CI 0.323-0.607; P < .001). This effect was observed in CP-B+AB patients (HR 0.524; 95% CI 0.307-0.896; P = .018) and in patients with Child-Pugh C scores below 14 points (HR 0.374; 95% CI 0.253-0.553; P < .001). Preemptive TIPS significantly improved control of bleeding and ascites without increasing risk of hepatic encephalopathy in Child-Pugh C and CP-B+AB patients, compared with drugs plus endoscopy. Cox analysis of patients who received preemptive TIPS showed that patients could be classified into 3 categories for risk of death, based on age, serum level of creatinine, and Child-Pugh score. In each of these risk categories, preemptive TIPS increased the proportion of patients who survived for 1 year, compared with drugs plus endoscopy.CONCLUSIONS: In a meta-analysis of data from 1327 patients with cirrhosis, acute variceal bleeding, and Child-Pugh score between 10 and 13 points or CP-B+AB, preemptive TIPS increased the proportion who survived for 1 year, in both subgroups separately, compared with drugs plus endoscopy.

AB - BACKGROUND & AIMS: Compared with drugs plus endoscopy, placement of transjugular portosystemic shunt within 72 hours of admission to the hospital (early or preventive transjugular intrahepatic portosystemic shunt [TIPS], also called preemptive TIPS) increases the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survive for 1 year. However, the benefit of preemptive TIPS is less clear for patients with a Child-Pugh score of B and active bleeding (CP-B+AB). We performed an individual data meta-analysis to assess the efficacy of preemptive TIPS in these patients and identify factors associated with reduced survival of patients receiving preemptive TIPS.METHODS: We searched publication databases for randomized controlled trials and observational studies comparing the effects of preemptive TIPS versus endoscopy plus nonselective beta-blockers in the specific population of high-risk patients with cirrhosis and acute variceal bleeding (CP-B+AB or Child-Pugh C, below 14 points), through December 31, 2019. We performed a meta-analysis of data from 7 studies (3 randomized controlled trials and 4 observational studies), comprising 1327 patients (310 received preemptive TIPS and 1017 received drugs plus endoscopy). We built adjusted models to evaluate risk using propensity score for baseline covariates. Multivariate Cox regression models were used to assess the factors associated with survival time. The primary endpoint was effects of preemptive TIPS versus drugs plus endoscopy on 1-year survival in the overall population as well as CP-B+AB and Child-Pugh C patients.RESULTS: Overall, preemptive TIPS significantly increased the proportion of high-risk patients with cirrhosis and acute variceal bleeding who survived for 1 year, compared with drugs plus endoscopy (hazard ratio [HR] 0.443; 95% CI 0.323-0.607; P < .001). This effect was observed in CP-B+AB patients (HR 0.524; 95% CI 0.307-0.896; P = .018) and in patients with Child-Pugh C scores below 14 points (HR 0.374; 95% CI 0.253-0.553; P < .001). Preemptive TIPS significantly improved control of bleeding and ascites without increasing risk of hepatic encephalopathy in Child-Pugh C and CP-B+AB patients, compared with drugs plus endoscopy. Cox analysis of patients who received preemptive TIPS showed that patients could be classified into 3 categories for risk of death, based on age, serum level of creatinine, and Child-Pugh score. In each of these risk categories, preemptive TIPS increased the proportion of patients who survived for 1 year, compared with drugs plus endoscopy.CONCLUSIONS: In a meta-analysis of data from 1327 patients with cirrhosis, acute variceal bleeding, and Child-Pugh score between 10 and 13 points or CP-B+AB, preemptive TIPS increased the proportion who survived for 1 year, in both subgroups separately, compared with drugs plus endoscopy.

KW - AVB

KW - HE

KW - Liver Disease

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=85097664689&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2020.09.026

DO - 10.1053/j.gastro.2020.09.026

M3 - Journal article

C2 - 32980344

VL - 160

SP - 193-205.e10

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 1

ER -