TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT PLACEMENT FOR VARICEAL BLEEDING - PREDICTORS OF MORTALITY

PURPOSE: To identify factors that predict survival in patients with va riceal bleeding who have undergone transjugular intrahepatic portosyst emic shunt (TIPS) placement. PATIENTS AND METHODS: TIPS was performed in 64 of 65 patients, Indications were bleeding esophagogastric varice s in 64 patients and hemorrhoidal bleeding in one, Child-Pugh classifi cations were A in two patients, B in 32, and C in 31. Acute bleeding w as controlled before TIPS in 26 patients in stable condition but not i n 39 patients whose condition was unstable. RESULTS: Twelve patients d ied within 30 days of TIPS, and another 14 died thereafter, The cumula tive survival rate was 67% at 6 months and 56% at 1 year, Cumulative 3 0-day survival was 96% for stable and 69% for unstable patients, a sig nificant difference (P = .0135). Thirty-day survival was 91% for patie nts in Child-Pugh classes A and B combined and 71% for patients in cla ss C (P = .042). CONCLUSION: Efforts to control acute bleeding and imp rove a patient's metabolic status before TIPS are likely to improve 30 -day survival.