[Analysis of the long-term prognosis of transjugular intrahepatic portosystemic shunt treatment for esophagogastric variceal hemorrhage concomitant with sarcopenia in cirrhotic patients].

Objective: To explore whether transjugular intrahepatic portosystemic shunt (TIPS) can improve the prognosis of esophagogastric variceal bleeding (EGVB) combined with sarcopenia in cirrhotic patients. Methods: A retrospective cohort study was performed. A total of 464 cases with cirrhotic EGVB who received standard or TIPS treatment between January 2017 and December 2019 were selected. Regular follow-up was performed for the long-term after treatment. The primary outcome was transplantation-free survival. The secondary endpoints were rebleeding and overt hepatic encephalopathy (OHE). The obtained data were statistically analyzed. The t -test and Wilcoxon rank-sum test were used to compare continuous variables between groups. The χ 2 test, or Fisher's exact probability test, was used to compare categorical variables between groups. Results: The age of the included patients was 55.27±13.86 years, and 286 cases were male. There were 203 cases of combined sarcopenia and 261 cases of non-combined sarcopenia. The median follow-up period was 43 months. The two groups had no statistically significant difference in follow-up time. There was no statistically significant difference in transplant-free survival between the TIPS group and the standard treatment group in the overall cohort ( HR =1.31, 95% CI : 0.97-1.78, P =0.08). The TIPS patient group with cirrhosis combined with sarcopenia had longer transplant-free survival (median survival: 47.76 vs. 52.45, χ 2 =4.09; HR =1.55, 95 CI : 1.01~2.38, P =0.04). There was no statistically significant difference in transplant-free survival between the two kinds of treatments for patients without sarcopenia ( HR =1.22, 95% CI : 0.78~1.88, P =0.39). Rebleeding time was prolonged in TIPS patients with or without sarcopenia combination (patients without combined sarcopenia: median rebleeding time: 39.48 vs. 53.61, χ 2 =18.68; R =2.47, 95 CI : 1.67~3.65, P <0.01; patients with sarcopenia: median rebleeding time: 39.91 vs. 50.68, χ 2 =12.36; HR =2.20, 95 CI : 1.42~3.40, P <0.01). TIPS patients had an increased 1-year OHE incidence rate compared to the standard treatment group (sarcopenia patients: 6.93% vs. 16.67%, χ 2 =3.87, P =0.049; patients without sarcopenia combination: 2.19% vs. 9.68%, χ 2 =8.85, P =0.01). There was no statistically significant difference in the long-term OHE incidence rate between the two kinds of treatment groups ( P >0.05). Conclusion: TIPS can significantly prolong transplant-free survival compared to standard treatment as a secondary prevention of EGVB concomitant with sarcopenia in patients with cirrhosis. However, its advantage is not prominent for patients with cirrhosis in EGVB without sarcopenia.