P64 Heart failure outcomes following transjugular intrahepatic portosystemic shunts
Notice bibliographique
Résumé
Background/Aims Transjugular intrahepatic portosystemic shunts (TIPSS) are increasingly used for the management of variceal bleeding and diuretic refractory ascites. Complications include cardiac failure in up to 20%. TIPSS outcomes over a 12-year period were reviewed for predictors of the occurrence of heart failure. Method Data was collated retrospectively for TIPSS performed at a tertiary referral centre between 2010 and 2022. The primary outcome was the occurrence of heart failure. Referring hospitals were contacted and information requested for data missing up to 12 month follow up. Statistical analysis included Mann-Whitney and t-tests for comparison of continuous variables between groups and binary logistic regression to determine predictive factors for the occurrence of heart failure. Results 472 patients underwent TIPSS, including 279 for ascites and 193 patients for variceal bleeding. Overall, 65% of patients were male and the mean age was 55 years. The most common aetiology was alcohol at 64%, 13% were due to metabolic dysfunction-associated steatotic liver disease and 8% were secondary to hepatitis C infection. Heart failure was documented in 80/472 (16.9%). Similar proportions of patients developed heart failure between the two groups, 48/279 (17.2%) in the ascites cohort and 32/193 (16.5%) in the variceal bleeding cohort. In 57.5% (46/80) heart failure was detected in the outpatient setting, most commonly due to new onset peripheral oedema, and was successfully managed with outpatient diuretic therapy. 10% (8/80) required re-admission to hospital for fluid overload (3% of the overall cohort). Five patients had multi-system involvement driving their symptoms as opposed to solely the TIPSS. Two patients required haemodialysis for fluid removal before subsequently undergoing TIPSS reductions as definitive management. Univariate analysis demonstrated the clinical factors of age and cryptogenic cirrhosis to be significant factors for heart failure, remaining independently predictive at multivariable analysis (Age: aOR 1.024, 95% C.I 1.001- 1.049, cryptogenic cirrhosis: aOR 2.979, 95% C.I 1.118–7.937). Cardiac risk factors were not predictive in this cohort. 82 patients had a pro-BNP within 6 months of their TIPSS, with no overall significant baseline increase in those who developed heart failure however, in the diuretic-refractory ascites cohort, the median baseline pro-BNP value was statistically higher in those with heart failure. Conclusion The majority of heart failure following TIPSS procedures is manageable in an outpatient setting and does not require re-admission to hospital or intervention beyond diuretic therapy. Cardiovascular risk factors did not predict the risk of heart failure in this cohort.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».