Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 15, Number 6, December 2022, pages 325-333

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

Figure 2. Forest plot of (a) post-TIPS HE in patients age < 70 vs. > 70, (b) 30-day mortality in patients age < 70 vs. > 70, (c) 90-day mortality in patients age < 70 vs. > 70, and (d) 30-day readmission rates due to HE in patients age < 70 vs. > 70. HE: hepatic encephalopathy; TIPS: transjugular intrahepatic portosystemic shunt.

**Table 1.** Quality Assessment of Studies via the MINORS Scale
Studies	Clearly stated aim	Consecutive patient inclusion	Prospective data collection	Appropriate end-points	Unbiased study end-point assessment	Appropriate follow-up period	Attrition bias (< 5%)	Sample size	Adequate control group	Contemporary groups	Baseline equivalence of groups	Statistical analysis	Total
MINORS: Methodological Index for Non-Randomized Studies.
Madhok et al [29]	2	2	2	2	0	2	2	0	2	2	2	1	19
Saad et al [33]	2	2	2	2	0	2	2	0	2	2	1	2	19
Kus et al [28]	2	2	2	2	0	2	2	0	2	2	0	2	18
Adlakha and Russo [32]	2	2	2	2	0	2	2	0	2	2	1	2	19
Stockhoff et al [31]	2	2	2	2	0	2	2	0	2	2	1	2	19
Bisht et al [30]	2	2	2	2	0	2	2	0	2	2	1	2	19

Table 1. Quality Assessment of Studies via the MINORS Scale

Studies

Clearly stated aim

Consecutive patient inclusion

Prospective data collection

Appropriate end-points

Unbiased study end-point assessment

Appropriate follow-up period

Attrition bias (< 5%)

Sample size

Adequate control group

Contemporary groups

Baseline equivalence of groups

Statistical analysis

Total

MINORS: Methodological Index for Non-Randomized Studies.

Madhok et al [29]

Saad et al [33]

Kus et al [28]

Adlakha and Russo [32]

Stockhoff et al [31]

Bisht et al [30]

**Table 2.** Study Characteristics for Patients Aged < 70 vs. > 70 Years
Study	Design	Demographics	Total number	Number of patients	MELD score	Indications for TIPS	Etiology of liver cirrhosis
MELD: Model for End-Stage Liver Disease; SD: standard deviation; TIPS: transjugular intrahepatic portosystemic shunt; HCV: hepatitis C virus; IQR: interquartile range; NASH: non-alcoholic steatohepatitis.
Adlakha and Russo [32]	Retrospective	Median age (IQR) in 50 - 59 years group = 55 (± 4) years; Median age (IQR) in 70 - 84 years group = 73 (± 6) years	100	50	50	Median (IQR) = 11 (± 6)	Median (IQR) = 11 (± 5)	Ascites = 16 (32%); Variceal bleed = 45 (90%); Hydrothorax = 6 (12%)	Ascites = 26 (52%); Variceal bleed = 38 (76%); Hydrothorax = 2 (4%)	HCV = 26 (52%); Alcohol = 13 (26%); NAFLD = 5 (10%); Other	NAFLD = 28 (56%); Alcohol = 8 (16%); Other
Saad et al [33]	Retrospective	Mean age (SD) in < 70 years group = 53.9 (± 8.9), range 24 - 69 years; Mean age (SD) in ≥ 70 years group = 75 (± 4.3), range 70 - 89 years	539	474	65	Mean (SD) = 11 (± 4)	Mean (SD) = 11 (± 3)	Ascites/hydrothorax = 338 (71%); -Variceal bleed = 126 (27%)	Ascites/hydrothorax = 42 (65%); Variceal bleed = 22 (34%)	HCV = 178 (38%); Alcohol = 142 (30%); NASH = 41 (9%); Other	Alcohol = 15 (23%); NASH = 12 (19%); HCV = 7 (11%); Other
Kus et al [28]	Retrospective	Mean age in 50 - 59 years group = 55 years; Mean age in ≥ 70 years group = 74 years	136	101	35	Mean MELD-Na = 21.8	Mean MELD-Na = 15.2	Complications of portal hypertension	Not reported

Table 2. Study Characteristics for Patients Aged < 70 vs. > 70 Years

Study

Design

Demographics

Total number

Number of patients

MELD score

Indications for TIPS

Etiology of liver cirrhosis

< 70 years

> 70 years

< 70 years

> 70 years

< 70 years

> 70 years

< 70 years

> 70 years

MELD: Model for End-Stage Liver Disease; SD: standard deviation; TIPS: transjugular intrahepatic portosystemic shunt; HCV: hepatitis C virus; IQR: interquartile range; NASH: non-alcoholic steatohepatitis.

Adlakha and Russo [32]

Retrospective

Median age (IQR) in 50 - 59 years group = 55 (± 4) years; Median age (IQR) in 70 - 84 years group = 73 (± 6) years

100

Median (IQR) = 11 (± 6)

Median (IQR) = 11 (± 5)

Ascites = 16 (32%); Variceal bleed = 45 (90%); Hydrothorax = 6 (12%)

Ascites = 26 (52%); Variceal bleed = 38 (76%); Hydrothorax = 2 (4%)

HCV = 26 (52%); Alcohol = 13 (26%); NAFLD = 5 (10%); Other

NAFLD = 28 (56%); Alcohol = 8 (16%); Other

Saad et al [33]

Retrospective

Mean age (SD) in < 70 years group = 53.9 (± 8.9), range 24 - 69 years; Mean age (SD) in ≥ 70 years group = 75 (± 4.3), range 70 - 89 years

539

474

Mean (SD) = 11 (± 4)

Mean (SD) = 11 (± 3)

Ascites/hydrothorax = 338 (71%); -Variceal bleed = 126 (27%)

Ascites/hydrothorax = 42 (65%); Variceal bleed = 22 (34%)

HCV = 178 (38%); Alcohol = 142 (30%); NASH = 41 (9%); Other

Alcohol = 15 (23%); NASH = 12 (19%); HCV = 7 (11%); Other

Kus et al [28]

Retrospective

Mean age in 50 - 59 years group = 55 years; Mean age in ≥ 70 years group = 74 years

136

101

Mean MELD-Na = 21.8

Mean MELD-Na = 15.2

Complications of portal hypertension

Not reported

**Table 3.** Study Characteristics for Patients Aged < 65 vs. > 65 Years
Study	Design	Demographics	Total number	Number of patients	MELD score	Indications for TIPS	Etiology of liver cirrhosis
MELD: Model for End-Stage Liver Disease; SD: standard deviation; TIPS: transjugular intrahepatic portosystemic shunt; HCV: hepatitis C virus; IQR: interquartile range; NASH: non-alcoholic steatohepatitis.
Madhok et al [29]	Retrospective	Mean age (SD) in < 65 years group = 57.75 (± 6.91) years; Mean age (SD) in ≥ 65 years group = 72.06 (± 5.98) years	254	127	127	Mean (SD) = 15.45 (± 4.95)	Mean (SD) = 14.87 (± 4.91)	Refractory ascites = 73 (57.4%); Variceal bleeding = 40 (31.5%)	Refractory ascites = 78 (61.4%); Variceal bleeding = 35 (27.1%)	Alcohol = 66 (52%); HCV = 49 (38.6%)	Alcohol = 78 (61.4%); HCV = 35 (27.6%)
Stockhoff et al [31]	Retrospective	Median age (IQR) in < 65 years group = 55 (49 - 59) years; Median age (IQR) in ≥ 65 years group = 70 (68 - 75) years	160	107	53	Median (IQR) = 12.7 (10.1 - 15.6)	Median (IQR) = 12.6 (10.8 - 15.9)	Refractory ascites	Viral = 12 (11%); Alcohol = 71 (66%); NASH = 6 (6%); Others = 22 (21%)	Viral = 7 (13%); Alcohol = 26 (49%); NASH = 6 (11%); Others = 14 (27%)
Bisht et al [30]	Retrospective	Mean age (SD) in ≤ 65 years group = 53 (± 9) years; Mean age (SD) in > 65 years group = 70 (± 5) years	402	300	102	Mean (SD) = 17.9 (± 8.07)	Mean (SD) = 16.2 (± 5.76)	Acute bleeding; Ascites; Hydrothorax	Alcohol; Viral hepatitis; NASH

Table 3. Study Characteristics for Patients Aged < 65 vs. > 65 Years

Study

Design

Demographics

Total number

Number of patients

MELD score

Indications for TIPS

Etiology of liver cirrhosis

< 65 years

> 65 years

< 65 years

> 65 years

< 65 years

> 65 years

< 65 years

> 65 years

Madhok et al [29]

Retrospective

Mean age (SD) in < 65 years group = 57.75 (± 6.91) years; Mean age (SD) in ≥ 65 years group = 72.06 (± 5.98) years

254

127

Mean (SD) = 15.45 (± 4.95)

Mean (SD) = 14.87 (± 4.91)

Refractory ascites = 73 (57.4%); Variceal bleeding = 40 (31.5%)

Refractory ascites = 78 (61.4%); Variceal bleeding = 35 (27.1%)

Alcohol = 66 (52%); HCV = 49 (38.6%)

Alcohol = 78 (61.4%); HCV = 35 (27.6%)

Stockhoff et al [31]

Retrospective

Median age (IQR) in < 65 years group = 55 (49 - 59) years; Median age (IQR) in ≥ 65 years group = 70 (68 - 75) years

160

107

Median (IQR) = 12.7 (10.1 - 15.6)

Median (IQR) = 12.6 (10.8 - 15.9)

Refractory ascites

Viral = 12 (11%); Alcohol = 71 (66%); NASH = 6 (6%); Others = 22 (21%)

Viral = 7 (13%); Alcohol = 26 (49%); NASH = 6 (11%); Others = 14 (27%)

Bisht et al [30]

Retrospective

Mean age (SD) in ≤ 65 years group = 53 (± 9) years; Mean age (SD) in > 65 years group = 70 (± 5) years

402

300

102

Mean (SD) = 17.9 (± 8.07)

Mean (SD) = 16.2 (± 5.76)

Acute bleeding; Ascites; Hydrothorax

Alcohol; Viral hepatitis; NASH

**Table 4.** Results Comparing Outcomes of Patients Aged < 70 vs. > 70 Years
Outcome	Relative risk	95% confidence interval	P-value	I²
HE: hepatic encephalopathy; TIPS: transjugular intrahepatic portosystemic shunt.
Post-TIPS HE	0.42	0.185 - 0.953	0.03	49%
30-day mortality	0.37	0.188 - 0.74	0.005	0%
90-day mortality	0.35	0.24 - 0.49	0.001	0%
30-day readmission due to HE	0.538	0.269 - 1.078	0.08	45%

Table 4. Results Comparing Outcomes of Patients Aged < 70 vs. > 70 Years

Outcome

Relative risk

95% confidence interval

P-value

I²

HE: hepatic encephalopathy; TIPS: transjugular intrahepatic portosystemic shunt.

Post-TIPS HE

0.42

0.185 - 0.953

0.03

49%

30-day mortality

0.37

0.188 - 0.74

0.005

90-day mortality

0.35

0.24 - 0.49

0.001

30-day readmission due to HE

0.538

0.269 - 1.078

0.08

45%

**Table 5.** Results Comparing Outcomes of Patients Aged < 65 vs. > 65 Years
Outcome	Relative risk	95% confidence interval	P	I²
HE: hepatic encephalopathy; TIPS: transjugular intrahepatic portosystemic shunt.
Post-TIPS HE	0.923	0.632 - 1.43	0.680	34%
30-day mortality	0.87	0.35 - 2.1	0.76	81%
90-day mortality	0.67	0.413 - 1.1	0.115	63%
30-day readmission due to HE	0.907	0.75 - 1.095	0.308	0%

Table 5. Results Comparing Outcomes of Patients Aged < 65 vs. > 65 Years

Outcome

Relative risk

95% confidence interval

I²

HE: hepatic encephalopathy; TIPS: transjugular intrahepatic portosystemic shunt.

Post-TIPS HE

0.923

0.632 - 1.43

0.680

34%

30-day mortality

0.87

0.35 - 2.1

0.76

81%

90-day mortality

0.67

0.413 - 1.1

0.115

63%

30-day readmission due to HE

0.907

0.75 - 1.095

0.308