Prognostic Factors in Survival after Portasystemic Shunts

Multivariate analyses correlated short-term survival and long-term survival with clinical data from 141 patients with portasystemic shunts for bleeding esophageal varices over the 8 years from 1974 through 1981. By logistic regression analysis, the elements with independent prognostic significance for operative death were an emergency operation, serum albumin and bilirubin levels, age, and sex. A cutpoint probability value of 0.75 marked the single level above which 84% of patients could be expected to survive, but below which 77% are likely to die. By a Cox regression model, elements with independent prognostic significance were identical. Male sex (p = 0.02) and prolonged partial thromboplastin time (p = 0.04) indicated a poor prognosis after an emergency operation; after an elective operation only the serum albumin level was prognostic (p = 0.02). Normal blood clotting is the major determinant of survival after an emergency shunt, and the serum albumin level chiefly determines survival after elective portasystemic decompression.