Outcome of Budd-Chiari syndrome: A multivariate analysis of factors related to survival including surgical portosystemic shunting

The aim of this study was to assess the factors, including surgical portosy stemic shunts, which affect survival in adults with Budd-Chiari syndrome. M ultivariate retrospective analysis was performed using characteristics reco rded at the time of diagnosis in 120 patients admitted from 1970 to 1992, o f is hom 82 were treated with surgical portosystemic shunts and 38 received only medical therapy. The 1-, 5-, and 10-year survival rates were 77 +/- 4 %, 64 +/- 9%, and 57 +/- 6%, respectively. Survival was significantly bette r in the subgroup of patients diagnosed after versus before 1985. In both s ubgroups, and in patients with, as well as in patients without surgical shu nts, 4 factors were found to be inversely and independently related to surv ival: age, response of ascites to diuretics, Pugh score, and serum creatini ne. In patients diagnosed since 1985, an index combining these 4 factors al lowed to differentiate patients with a good outcome (5-year survival 95%) f rom those with a poor outcome (5-year survival 62%; P <.05), There was no s tatistically significant and independent influence of surgical portosystemi c shunts on survival. In conclusion, age, severity of liver failure, and pr esence of refractory ascites are the main prognostic factors in Budd-Chiari syndrome. Increased survival in recent years is consistent with improved m anagement of hypercoagulable states as well as improved general care. It is uncertain whether surgical portosystemic shunting favorably modifies survi val. Therefore, we recommend that surgical shunting should be restricted to management of refractory ascites or variceal bleeding in patients with oth erwise good prognostic factors.