Esophageal Varicose Veins Clinical Trial
Official title:
Does Early TIPS Improve Survival for Cirrhotic Patients With Acute Esophageal Variceal Bleeding Admitted in Intensive Care Unit?
Acute esophageal variceal bleeding (AEVB) is a serious complication of cirrhosis, with high
morbidity and mortality. The latest European recommendations(1) recommend the early
implementation, within 72 hours following esophageal variceal bleeding, of a transhepatic
porto-systemic shunt set up by transjugular route (TIPS) called "early TIPS" in patients at
high risk of recurrence, i.e. Child C<14 or Child B with active bleeding at the time of
endoscopy. The implementation of early TIPS appears to improve survival without
transplantation in these patients, although the benefit among Child B patients without active
bleeding has yet to be demonstrated.
Renal failure is a determining factor in the prognosis of the cirrhotic patient. For patients
with refractory ascites, or type 2 hepato-renal syndrome (i.e. chronic renal failure related
to portal hypertension), the use of TIPS is recommended. Although a few studies with low
levels of evidence have reported a benefit in the placement of TIPS in hepato-renal syndrome
type 1 (i.e. acute renal failure related to portal hypertension), the European
recommendations do not recommend the use of TIPS in this context due to lack of studies on
the subject. Some studies have shown an improvement in renal function after performing TIPS
in refractory ascites. To date, no studies have evaluated the impact of the implementation of
early-TIPS on renal function in intensive care patients.
The investigators would like to evaluate the impact on survival without liver transplantation
on D28 of the implementation of early-TIPS in cirrhotic patients with AEVB requiring ICU
hospitalization, compared to standard treatment (medical and endoscopic).
Using electronic patient data monitoring systems, the investigators reviewed all patients with a diagnosis of cirrhosis admitted to ICUs at the Nantes University Hospital, and departmental Hospital of Vendée from January 1, 2012, to december 31, 2018. For enrolled patients, general clinical characteristics were collected. Patients were categorized into two groups according to the type of treatment performed: early TIPS or standard treatment. ;