Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations

Sahaj Rathi; Silvia Brocco; Chiara Formentin; Lisa Zarantonello; Chiara Mangini; Gianluca Meneghello; Carlo Merkel; Paolo Angeli; Roberto Stramare; Sara Montagnese; Piero Amodio

doi:10.1016/j.dld.2020.11.020

Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations

Dig Liver Dis. 2021 Nov;53(11):1468-1475. doi: 10.1016/j.dld.2020.11.020. Epub 2020 Dec 16.

Affiliations

¹ Department of Medicine-DIMED(,) University of Padova, Padova, Italy; Post Graduate Institute of Medical Education and Research, Chandigarh, India; Department of Earth, Atmospheric and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States.
² Department of Medicine-DIMED(,) University of Padova, Padova, Italy.
³ Department of Earth, Atmospheric and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States.
⁴ Department of Medicine-DIMED(,) University of Padova, Padova, Italy. Electronic address: piero.amodio@unipd.it.

PMID: 33341422
DOI: 10.1016/j.dld.2020.11.020

Abstract

Background: Spontaneous portosystemic shunts (SPSS) are common in cirrhosis. Their characterization and clinical implications remain unclear.

Aims: To devise a system of assessment of these shunts, and assess their clinical implications METHODS: We retrospectively studied patients with cirrhosis who underwent imaging in a liver transplant program. A novel index was computed to assess total SPSS -the diameter of a circle having an area equivalent to the sum of the areas of all the existing shunts. This 'SPSS equivalent diameter' was compared with the clinical variables.

Results: Among 127 patients, 70% (CI_95% 62-77) had SPSS, and 57% (CI_95% 62-77) had multiple SPSS. The risk for SPSS was related to the severity of cirrhosis (Child-Pugh B/C vs. A: OR 2.4 CI_95% 1.1-5.4) and alcoholic aetiology (OR 2.9 CI_95% 1.2-7.1). The SPSS equivalent diameter was related to a history of HE, cognitive impairment (EEG/PHES) and ammonia(p<0.05). The diameter of the inferior cava vein >19.5 mm was a predictor of large SPSS (AUC 0.77, CI_95%:0.68-0.87, p ≤ 0.001).

Conclusions: The SPSS equivalent diameter, a comprehensive assessment of portosystemic shunting, was associated with severity of liver disease, hyperammonemia, and cognitive dysfunction. The diameter of the inferior vena cava was a good predictor of SPSS.

Keywords: Cirrhosis; Hepatic encephalopathy; Portal hypertension; Portosystemic shunt.

MeSH terms

Aged
Esophageal and Gastric Varices / pathology
Female
Hepatic Encephalopathy / complications
Hepatic Encephalopathy / diagnosis
Hepatic Encephalopathy / pathology*
Humans
Liver Cirrhosis / complications
Liver Cirrhosis / diagnostic imaging
Liver Cirrhosis / physiopathology*
Male
Middle Aged
Retrospective Studies
Severity of Illness Index