Abstract No. 377 Prognostic Value of Portal Venous Gradients in Predicting Mortality Following TIPS Procedure

To determine if pre-intervention portal venous gradient (PVG) or overall reduction in PVG are independent predictors of early or late mortality in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) creation. A single-center retrospective review was performed on patients undergoing TIPS from January 2018 to September 2022. 103 patients were identified, of which 88 patients met inclusion criteria (Table 377.1). Exclusion criteria were non-cirrhotic etiology of portal hypertension, emergent indication or patient lost to follow up earlier than 30-days. Primary outcomes included mortality at 30-days, 90-days and 1-year following TIPS. Statistical analysis was performed with Chi-squared test, Student's T-test and logistic regression models. There was no significant variation in the mean difference of pre-TIPS PVG when comparing patient groups based on survival at 30-days (-1.73 mm Hg, p=0.33), 90-days (0.04 mm Hg, p=0.98) or 1-year (1.7 mm Hg, p=0.21). When comparing patients with a pre-TIPS PVG less than 20 mm Hg versus greater than 20 mm Hg, there was no significant difference in mortality at 30-days (10% [6/58] vs 7% [2/30], p=0.63), 90-days (14% [8/57] vs 17% [5/30], p=0.8) or 1-year (14% [8/57] vs 25% [7/28], p=0.28). Logistic regression analysis demonstrated medium strength correlation between greater reduction in PVG and higher incidence of mortality at 30-days (η=0.451, p=0.593), 90-days (η=0.606, p=0.044) and 1-year (η=0.603, p=0.057). While initial and post PVG measurements remain crucial in decision-making during TIPS procedures, this study indicates pre-TIPS PVG alone may not reliably predict mortality. Notably, a moderate and statistically significant correlation between PVG reduction and 90-mortality was observed. This may play a role in stratifying patient risk post-procedure; however, further investigations are warranted to validate this finding.