EFFECTS OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS ON HEPATIC METABOLIC FUNCTION DETERMINED WITH SERIAL MONITORING OF ARTERIAL KETONE-BODIES

PURPOSE: To investigate the effects of transjugular intrahepatic porto systemic shunt (TIPS) on hepatic metabolic function by measuring seria l arterial ketone body ratio (acetoacetate/-hydroxybutyrate; AKBR). MA TERIAL AND METHODS: The arterial blood of 30 TIPS patients was assayed before TIPS, 30 minutes after TIPS, and 24 hours after TIPS for aceto acetate, beta-hydroxybutyrate, and glucose, The authors compared the A KBR values to clinical outcome stratified by Child class, emergent ver sus elective TIPS, and before-TIPS AKBR value less than or equal to 0. 5 versus before-TIPS AKBR value > 0.5.RESULTS: A significant change wa s noted between the AKBR values obtained before TIPS and values 30 min utes after TIPS (0.76 +/- 0.09 vs 0.61 +/- 0.05, P < .05) and between 30 minutes and 24 hours after TIPS (0.81 +/- 0.10, P < .001), but not between the value obtained before TIPS and that obtained 24 hours afte r TIPS, The 30-day mortality rate in emergency TIPS patients was 50% c ompared to 7% in the elective TIPS patients (P < .01), The pre-TIPS AK BR values were significantly suppressed in the emergency TIPS patients compared to the elective TIPS patients (0.56 +/- 0.04 vs 0.99 +/- 0.1 7, P < .005), The 30-day mortality rate in patients with a pre-TIPS AK BR value less than or equal to 0.5 was 75%, which was significantly hi gher than the 14% rate in patients with a pre-TIPS AKBR value > 0.5 (P < .01). CONCLUSION: A low pre-TIPS AKBR may be predictive of poor out come after TIPS, Furthermore, AKBR may be of value in determining the timing for performing an elective TIPS.