Transjugular Intrahepatic Portosystemic Shunt Outcomes in the Elderly Population: A Systematic Review and Meta-Analysis

Zohaib Ahmed; Umer Farooq; Syeda Faiza Arif; Muhammad Aziz; Umair Iqbal; Ahmad Nawaz; Wade Lee-Smith; Joyce Badal; Asif Mahmood; Abdallah Kobeissy; Ali Nawras; Mona Hassan; Sammy Saab

doi:10.14740/gr1571

Transjugular Intrahepatic Portosystemic Shunt Outcomes in the Elderly Population: A Systematic Review and Meta-Analysis

Gastroenterology Res. 2022 Dec;15(6):325-333. doi: 10.14740/gr1571. Epub 2022 Dec 1.

Authors

Zohaib Ahmed¹, Umer Farooq², Syeda Faiza Arif³, Muhammad Aziz⁴, Umair Iqbal⁵, Ahmad Nawaz⁶, Wade Lee-Smith⁷, Joyce Badal⁸, Asif Mahmood¹, Abdallah Kobeissy⁴, Ali Nawras⁴, Mona Hassan⁴, Sammy Saab⁹

Affiliations

¹ Department of Internal Medicine, University of Toledo, Toledo, OH, USA.
² Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Chicago, IL, USA.
³ Dow University of Health Sciences, Karachi, Pakistan.
⁴ Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA.
⁵ Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA.
⁶ Division of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA.
⁷ University of Toledo Libraries, University of Toledo, Toledo, OH, USA.
⁸ University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
⁹ Department of Medicine and Surgery at the David Geffen School of Medicine at UCLA (University of California Los Angeles), Los Angeles, CA, USA.

PMID: 36660467
PMCID: PMC9822662
DOI: 10.14740/gr1571

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure typically utilized to treat refractory ascites and variceal bleeding. However, TIPS can lead to significant complications, most commonly hepatic encephalopathy (HE). Advanced age has been described as a risk factor for HE, as the elderly population tends to have decreased cognitive reserve and increased sarcopenia. We conducted a systematic review and meta-analysis of the available literature to summarize the association between advanced age and risk of adverse events after undergoing TIPS.

Methods: A comprehensive search strategy to identify reports of specific outcomes (HE, 30-day and 90-day mortality, and 30-day readmission due to HE) in elderly patients after undergoing TIPS was developed in Embase (Embase.com, Elsevier). We compared outcomes and performed separate data analyses for patients aged < 70 vs. > 70 years and patients aged < 65 vs. > 65 years.

Results: Six studies with a total of 1,591 patients met our inclusion criteria and were included in the final meta-analysis. Three studies divided patients by age < 65 vs. > 65 years, with a total of 816 patients who were 54% male. The remaining three studies divided patients by age < 70 vs. > 70 years, with a total of 775 patients who were 63% male. Results demonstrated a significantly lower risk of post-TIPS HE (risk ratio (RR): 0.42, confidence interval (CI): 0.185 - 0.953, P = 0.03, I² = 49%), 30-day mortality (RR: 0.37, CI: 0.188 - 0.74, P = 0.005, I² = 0%), and 90-day mortality (RR: 0.35, CI: 0.24 - 0.49, P = 0.001, I² = 0%) in patients aged > 70 vs. < 70 years, as well as a trend towards lower risk of 30-day readmission due to HE. There was no significant difference in post-TIPS HE, 30-day or 90-day mortality, or 30-day readmission due to HE between patients aged < 65 vs. > 65 years.

Conclusion: Age > 70 years is associated with significantly higher rates of HE and 30-day and 90-day mortality rates in patients after undergoing TIPS, as well as a trend towards higher 30-day readmission due to HE.

Keywords: Elderly age; Hepatic encephalopathy; Morbidity; Mortality; Refractory ascites; Transjugular intrahepatic portosystemic shunt; Variceal bleeding.