TIPS placement as the first-line therapy to prevent variceal rebleeding in patients with cirrhosis and sarcopenia

Sarcopenia increases the risk of mortality and hepatic encephalopathy (HE) in cirrhosis, and is a potential indication for transjugular intrahepatic portosystemic shunt (TIPS). The aim was to investigate the prognostic effect of sarcopenia in patients with cirrhosis who received TIPS for prevention of variceal rebleeding.

We retrospectively included 262 patients with cirrhosis receiving TIPS as the first-line treatment for prevention of rebleeding. L3 skeletal muscle index (SMI) was measured and sarcopenia was defined using sex-specific cutoffs. Incidence of post-TIPS mortality and overt HE, and changes of L3-SMI before and after TIPS were compared between the non-sarcopenia and sarcopenia group. Moreover, 21 patients with sarcopenia who received TIPS as the second-line treatment were included for additional comparison.

At admission, 99 (37.8 %) and 163 (62.2 %) patients were diagnosed as sarcopenia and non-sarcopenia, respectively. Compared with the non-sarcopenia group, the sarcopenia group had a similar risk of mortality (adjusted hazard ratio [HR] 1.04, 95 % confidence interval [CI]: 0.55-1.96, p = 0.900) and overt HE (adjusted HR 1.20, 95 %CI 0.72-2.00, p = 0.479). The sarcopenia group achieved higher extent of L3-SMI improvement after TIPS than the non-sarcopenia group (7.0 vs 2.4 cm²/m² in males; 4.2 vs 3.3 cm²/m² in females). For patients with sarcopenia, TIPS as the second-line treatment significantly increased mortality risk compared with TIPS as the first-line treatment (adjusted HR 2.68, 95 %CI 1.05-6.87, p = 0.04).

For patients treated with TIPS as the first-line treatment for prevention of rebleeding, baseline sarcopenia did not increase the risk of post-TIPS mortality and overt HE.