This study investigated the incidence, risk factors, and prognostic implications of acute kidney injury (AKI) after transjugular intrahepatic portosystemic shunt (TIPS). This multicenter retrospective study included patients who underwent TIPS at three hospitals in China. AKI risk factors were identified using multivariate logistic regression in the overall cohort. Propensity score matching was performed to balance baseline covariates. Survival differences were assessed using the Kaplan-Meier method, and the association between AKI and mortality was evaluated using stratified Cox regression models. A total of 995 patients were included, of whom 4.92% developed postoperative AKI. Multivariable analysis identified older age (OR: 1.07, 95% CI: 1.04-1.10), higher preoperative neutrophil percentage (OR: 1.05, 95% CI: 1.02-1.08), elevated preoperative creatinine (OR: 1.01 per μmol/L, 95% CI: 1.00-1.01), and an increased Child-Pugh score (OR: 1.27, 95% CI: 1.01-1.59) as independent risk factors for AKI. AKI was strongly associated with increased overall mortality (p < 0.001). In the propensity score-matched cohort, postoperative AKI remained an independent predictor of worse long-term survival (HR: 4.09, 95% CI: 1.97-8.50). In conclusion, age, preoperative neutrophil percentage, creatinine level, and Child-Pugh score were independent risk factors for AKI following TIPS, and the development of AKI is strongly associated with a poor prognosis in these patients.
Shang et al. (Mon,) studied this question.