P64 Heart failure outcomes following transjugular intrahepatic portosystemic shunts
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".