TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis
Abstract
BACKGROUND AND AIMS
Further decompensation represents a prognostic stage of cirrhosis associated with higher mortality than first decompensation. A transjugular intrahepatic portosystemic shunt (TIPS) is indicated to prevent variceal rebleeding and for refractory ascites, but its overall efficacy to prevent further decompensations is unknown. This study aimed to assess (i) the incidence of further decompensation and (ii) mortality after TIPS vs. standard of care (SOC).
METHODS
Controlled studies assessing covered TIPS in comparison to SOC in the indication of refractory ascites and prevention of variceal rebleeding published from 2004 until 2020 were considered. We collected individual patient data (IPD) to perform an IPD meta-analysis and to compare the treatment effect in a propensity score (PS) matched population. Primary outcome was the incidence of further decompensation and the secondary outcome was overall survival.
RESULTS
3949 individual patient datasets were extracted from 12 controlled studies, and after PS matching, 2338 patients with similar characteristics (SOC=1749; TIPS=589) were analyzed. The two-year cumulative incidence function of further decompensation in the PS-matched population was 0.48 (0.43-0.52) in the TIPS group vs. 0.63 (0.61-0.65) in the SOC group (stratified Gray's test, p<0.0001), considering mortality and liver transplantation as competing events. The lower further decompensation rate with TIPS was confirmed by adjusted IPD meta-analysis…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,338 participants or records.
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