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Ann Intern Med. 1998 Mar 1;128(5):374-7.

Severe hyperbilirubinemia after creation of transjugular intrahepatic portosystemic shunts: natural history and predictors of outcome.

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  • 1University of California, San Francisco, 94143, USA.

Abstract

BACKGROUND:

Hyperbilirubinemia after creation of transjugular intrahepatic portosystemic shunts (TIPS) has been attributed to hemolysis and portal diversion, but the causes and natural history of this condition remain unknown.

OBJECTIVE:

To determine clinical outcomes and predictors of severe hyperbilirubinemia after TIPS creation.

DESIGN:

Retrospective analysis of all patients who underwent TIPS creation from June 1990 to September 1996.

SETTING:

Academic medical center.

PATIENTS:

19 adults who developed severe hyperbilirubinemia (bilirubin level > 171.0 micromol/L) within 1 month after TIPS creation were compared with 213 adults who did not develop hyperbilirubinemia after TIPS creation.

INTERVENTION:

TIPS creation.

MEASUREMENTS:

Laboratory measures and clinical outcomes.

RESULTS:

According to laboratory indices, hemolysis was unlikely to have occurred. By 90 days, 95% of patients with hyperbilirubinemia had died or had undergone liver transplantation compared with 17% of controls (P < 0.001). Predictors of hyperbilirubinemia included nonalcoholic causes of liver disease (P = 0.01) and a pre-TIPS prothrombin time of 17 seconds or more (P = 0.016).

CONCLUSIONS:

Severe hyperbilirubinemia after TIPS creation heralds a high risk for death or need for liver transplantation. Reduced hepatic reserve predicts the development of hyperbilirubinemia.

PMID:
9490598
[PubMed - indexed for MEDLINE]
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