Liver and renal function, systemic circulation, and vasoactive mediators during the first weeks after transjugular intrahepatic portosystemic stent-shunt (TIPS) insertion
| Characteristic | Baseline (n=31) | Week 1 (n=30) | Week 2 (n=30) | Week 4 (n=29) |
| Liver function | ||||
| Child-Pugh score | 9.5 (1.4) | 9.4 (1.8) | 9.3 (1.8) | 8.8 (1.8) |
| Bilirubin (mg/dl) | 3.1 (3.3) | 4.4 (6.3) | 4.1 (7.5) | 3.2 (1.9) |
| Albumin (g/dl) | 2.9 (0.5) | 2.9 (0.5) | 3.4 (0.6)2-a | 3.3 (0.7) |
| Prothrombin time (%) | 74 (22) | 72 (25) | 76 (21)2-b | 77 (20) |
| Ascites score | 3 (0) | 2.7 (0.4) | 2.4 (0.6)2-a | 2.1 (0.6) |
| Renal function | ||||
| Serum creatinine (mg/dl) | 2.3 (1.7) | 1.7 (1.4)2-c | 1.6 (1.1)2-c | 1.5 (1.2)2-b |
| Creatinine clearance (ml/min) | 18 (15) | 42 (42)2-c | 48 (48)2-c | 44 (28)2-c |
| Serum urea (mg/dl) | 68 (42) | 52 (33)2-c | 47 (32)2-c | 55 (46)2-b |
| Sodium excretion (mmol/24 h) | 12 (16) | 38 (29)2-c | 77 (78)2-c | 91 (60)2-c |
| Urine volume (ml/24 h) | 544 (373) | 788 (692)2-a | 1041 (625)2-c | 1248 (621)2-c |
| Systemic circulation | ||||
| Heart rate (beats/min) | 80.2 (8) | 79.7 (10) | 84.0 (10)2-a | 82.9 (10) |
| Mean arterial pressure (mm Hg) | 69.4 (9) | 69.4 (7) | 75.0 (9)2-a | 74.9 (7)a |
| Vasoactive mediators | ||||
| ET-1 (pmol/l) | ||||
| Systemic | 1.31 (0.5); n=20 | 1.39 (0.9); (n=20) | ||
| Portal | 2.05 (0.7)2-162; n=20 | 1.32 (0.4)2-160; (n=20) | ||
| PRA (ng/ml/3 h)2-1 | ||||
| Systemic | 49 (34); n=12 | 26 (26)2-151; (n=12) | ||
| Portal | 48 (31); n=12 | 28 (25)2-151; (n=12) | ||
| AR (ng/l)2-2 | ||||
| Systemic | 224 (135); n=8 | 138 (116)2-160; (n=8) | ||
| Portal | 199 (120); n=8 | 112 (117)2-160; (n=8) | ||
Parameters (mean (SD)) of liver and renal function, and systemic circulation (heart rate, mean arterial pressure (MAP)) before and up to four weeks after TIPS.
Baseline endothelin-1 (ET-1) and renin-angiotensin system activation (estimated by plasma renin activity (PRA) or active renin (AR)) in the systemic venous and portal circulation were determined in the last consecutive 24 patients and repeated two weeks after TIPS in 20 patients.
Within four weeks, MANOVA detected significant improvements in all renal function parameters, ascites score, and MAP, whereas changes in biochemical liver function parameters showed only a trend towards transient deterioration. Differences over time versus baseline were compared for renal function parameters, ascites score, and MAP for one, two, and four week intervals, whereas all other parameters were tested once for the two week interval.
Differences in liver and renal function vbaseline:
↵2-a p<0.05,
↵2-b p<0.01,
↵2-c p<0.001.
Vasoactive mediators:
↵2-1 PRA: baselinev control (n=12);
↵2-2 AR: baselinev control (n=8).
↵2-162 Portal v systemic ET-1 baseline levels, p<0.01;
↵2-151 control v baseline, p<0.05;
↵2-160 control v baseline, p<0.01.