Evidence map›Paper›PMID 39817366›Full record

ArticleAlimentary pharmacology & therapeutics2025

Early Dynamics of Portal Pressure Gradient After TIPS Insertion Predict Mortality.

P A Reuken, A Franz, T H Wirtz, C Ripoll, R Aschenbach, U Teichgräber, M R Pollmanns, M Kiehntopf, S Keil, C Kuhl and 5 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Alimentary pharmacology & therapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

P A ReukenDepartment of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.ORCID https://orcid.org/0000-0002-7696-475X
A FranzDepartment of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
T H WirtzMedical Department III, University Hospital RWTH Aachen, Aachen, Germany.ORCID https://orcid.org/0000-0003-2778-2447
C RipollDepartment of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.ORCID https://orcid.org/0000-0002-9704-4741
R AschenbachDepartment of Radiology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
U TeichgräberDepartment of Radiology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
M R PollmannsMedical Department III, University Hospital RWTH Aachen, Aachen, Germany.
M KiehntopfInstitute of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.
S KeilDepartment of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
C KuhlDepartment of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
P C SchulzeDivision of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
C TrautweinMedical Department III, University Hospital RWTH Aachen, Aachen, Germany.
T BrunsMedical Department III, University Hospital RWTH Aachen, Aachen, Germany.ORCID https://orcid.org/0000-0002-5576-6914
A StallmachDepartment of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.ORCID https://orcid.org/0000-0002-6101-5244
A ZipprichDepartment of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.ORCID https://orcid.org/0000-0001-8403-7983

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTransjugular intrahepatic portosystemic shunt (TIPS) placement leads to a reduction in portal pressure and an improvement in survival in patients with recurrent and refractory ascites and variceal haemorrhage. Prediction of post-TIPS survival is primarily determined by factors identified before the TIPS procedure, as data collected during or after TIPS implantation are limited. The aim of the study was to evaluate the influence of early hemodynamic changes after TIPS placement on survival, in order to refine post TIPS management.

methodsIn this prospective bicentric study, consecutive patients (n = 105) undergoing TIPS placement for ascites or variceal haemorrhage underwent measurement of portal pressure gradient (PPG) immediately at TIPS insertion (PPG0) and 24 h later (PPG24h) and the ΔPPG was calculated from PPG24h and PPG0 (ΔPPG = PPG24h-PPG0). Kaplan-Meier survival analysis and uni- and multivariable regression analyses were conducted to identify survival predictors.

resultsPatients with lack of increased ΔPPG exhibited poorer 90-day and 1-year survival compared to patients with increased ΔPPG. This worse survival was independent of The Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, bilirubin levels, creatinine and the Freiburg index of post-TIPS survival (FIPS) > 0.92. Among these patients with poorer outcome, elevated bilirubin (> 25 μmol/L) further distinguished survivors from non-survivors.

conclusionLack of increased ΔPPG post-TIPS insertion identifies a high-risk patient group with worse survival. We propose incorporating this second PPG measurement and determining ΔPPG into clinical practice to identify these patients early and tailor post-TIPS patient care.

Indexed as

AscitesEsophageal and Gastric VaricesGastrointestinal HemorrhageHypertension, PortalPortal PressurePortasystemic Shunt, Transjugular IntrahepaticAdultAgedFemaleHumansKaplan-Meier EstimateMaleMiddle AgedProspective StudiesTreatment Outcomeascitescirrhosisportal pressure gradientTIPS

Identifiers

PMID39817366
PMCPMC11908110

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.