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Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations

2020; Elsevier BV; Volume: 53; Issue: 11 Linguagem: Inglês

10.1016/j.dld.2020.11.020

1878-3562

Sahaj Rathi, Silvia Brocco, Chiara Formentin, Lisa Zarantonello, Chiara Mangini, Gianluca Meneghello, Carlo Merkel, Paolo Angeli, Roberto Stramare, Sara Montagnese, Piero Amodio,

Organ Transplantation Techniques and Outcomes

Spontaneous portosystemic shunts (SPSS) are common in cirrhosis. Their characterization and clinical implications remain unclear.To devise a system of assessment of these shunts, and assess their clinical implications METHODS: We retrospectively studied patients with cirrhosis who underwent imaging in a liver transplant program. A novel index was computed to assess total SPSS -the diameter of a circle having an area equivalent to the sum of the areas of all the existing shunts. This 'SPSS equivalent diameter' was compared with the clinical variables.Among 127 patients, 70% (CI95% 62-77) had SPSS, and 57% (CI95% 62-77) had multiple SPSS. The risk for SPSS was related to the severity of cirrhosis (Child-Pugh B/C vs. A: OR 2.4 CI95% 1.1-5.4) and alcoholic aetiology (OR 2.9 CI95% 1.2-7.1). The SPSS equivalent diameter was related to a history of HE, cognitive impairment (EEG/PHES) and ammonia(p 19.5 mm was a predictor of large SPSS (AUC 0.77, CI95%:0.68-0.87, p ≤ 0.001).The SPSS equivalent diameter, a comprehensive assessment of portosystemic shunting, was associated with severity of liver disease, hyperammonemia, and cognitive dysfunction. The diameter of the inferior vena cava was a good predictor of SPSS.