Comment on systemic inflammation after TIPS in decompensated cirrhosis

Intrahepatic Portosystemic Shunt Leads toSustained Reversal of Systemic Inflammation in Patients With Decompensated Liver Cirrhosis". 1 By longitudinally measuring multiple soluble inflammatory markers, this study provides important data for understanding the dynamic changes in systemic inflammation after transjugular intrahepatic portosystemic shunt (TIPS) placement.Another recent study also observed a reduction in interleukin-6 levels after TIPS and an association between this reduction and clinical outcomes, 2 further underscoring the importance of this research area.However, we believe that several aspects of the reporting and interpretation of the findings require clarification.First, both the Abstract and the Study Highlights state that soluble CD14 (sCD14) decreased significantly at 6 months after TIPS.However, Figure 6 shows no statistically significant difference in sCD14 from baseline at 1, 3, or 6 months; statistical significance was reached only at 12 months (P = 0.017).The Results section also explicitly states that sCD14 decreased significantly from baseline to 12 months.Therefore, the statement that sCD14 decreased significantly at 6 months appears inconsistent with the main text and figure.Given that only 21 patients had available data at 12 months, the correct time point and corresponding sample size should be accurately reported in the Abstract and Study Highlights.Second, there is also an inconsistency between the white blood cell count (WBC) results and the summary statements.The authors reported no significant change in WBC from baseline to 6-12 months, with no significant change observed during longerterm follow-up at 2 and 3 years.Changes in WBC were also not associated with subsequent clinical outcomes.Nevertheless, the article concludes that TIPS markedly improved systemic inflammation, as reflected by changes in soluble inflammatory markers, C-reactive protein (CRP), and WBC.Because WBC did not show a statistically significant change at any time point, a more accurate statement should distinguish the reductions in CRP and selected inflammatory markers from the negative WBC findings.Third, the definition and interpretation of the outcome in the survival analysis warrant further consideration.The Methods