Utility of Advanced Age as a Predictor of Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt

Introduction: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for managing major complications of cirrhosis including refractory ascites, hydrothorax, and variceal bleed. The impact of advanced age on outcomes of TIPS has not been studied comprehensively. Therefore, we aimed to study optimal advanced age cutoff in context of MELD score for patients undergoing TIPS. Methods: A single-center retrospective analysis of all adult patients with cirrhosis, who underwent TIPS between 2002 and 2020 was performed. Univariate and multivariate analyses were conducted to determine the development of hepatic encephalopathy (HE) and mortality at 30 days and 1 year. The impact of various age groups (55, 60, 65, and 70 years) and MELD score cutoffs on mortality were elucidated. Results: A total of 225 patients were included. No significant associations were found between advanced age and short-term mortality (p = 0.410), short-term development of HE (p = 0.846), or secondary post-TIPS outcomes such as rebleed or need for paracentesis. However, advanced age was associated with significant differences in post TIPS mortality (p = 0.026) and inpatient development of HE (p = 0.032) at 1-year. These associations were confirmed in multivariate models. Area under the covariate adjusted receiver operating curve (AUROC) identified optimal age and MELD cutoffs as 60 years and 15 for 1-year mortality, respectively. An optimal age cutoff of 54 was identified for 1-year HE. Conclusions: Advanced age is strongly associated with 1-year mortality and 1-year development of HE post-TIPS. Poorer post-TIPS outcomes were further observed in patients with higher MELD. Therefore, during selection of advanced age patients for TIPS, MELD score should be considered for better long-term outcomes.