{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:09:08Z","timestamp":1790104148613,"version":"4.0.1"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T00:00:00Z","timestamp":1626652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T00:00:00Z","timestamp":1626652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Data about the prognosis of salvage transjugular intrahepatic portosystemic shunt (TIPS) using covered stents for refractory variceal bleeding caused by portal hypertension are scarce. We aimed to assess survival and to identify predictors of mortality in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach and Results<\/jats:title>\n                    <jats:p>\n                      One hundred sixty\u2010four patients with cirrhosis from five centers treated with salvage TIPS between 2007 and 2017 were retrospectively divided into a derivation cohort (83 patients) and a validation cohort (81 patients). Comparisons were performed using the Mann\u2010Whitney and Fischer\u2019s exact test. Six\u2010week overall survival (OS) was correlated with variables on the day of the TIPS using Kaplan\u2010Meier curves with log\u2010rank test and univariate\/multivariate analyses using the Cox model. Eighty\u2010three patients were included in the derivation cohort (male, 78%; age, 55\u00a0years, alcohol\u2010associated cirrhosis, 88%; Model for End\u2010Stage Liver Disease [MELD], 19 [15\u201027]; arterial lactate, 3.7\u00a0mmol\/L [2.0\u20108.3]). Six\u2010week OS rate was 58%. At multivariate analysis, the MELD score (OR, 1.064; 95% CI, 1.005\u20101.126;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.028) and arterial lactate (OR, 1.063; 95% CI, 1.013\u20101.114;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.032) were associated with 6\u2010week OS. Six\u2010week OS rates were 100% in patients with arterial lactate \u22642.5\u00a0mmol\/L and MELD score\u00a0\u2264\u00a015 and 5% in patients with lactate \u226512\u00a0mmol\/L and\/or MELD score\u00a0\u2265\u00a030. The 81 patients of the validation cohort had similar MELD and arterial lactate level but lower creatinine level (94\u00a0vs 106\u00a0\u00b5mol\/L,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.008); 6\u2010week OS was 67%. Six\u2010week OS rates were 86% in patients with arterial lactate \u22642.5\u00a0mmol\/L and MELD score\u00a0\u2264\u00a015 and 10% for patients with lactate \u226512\u00a0mmol\/L and\/or MELD score\u00a0\u2265\u00a030. In the overall cohort, rebleeding rate was 15.8% at 6\u00a0weeks, and the acute\u2010on\u2010chronic liver failure grade (OR, 1.699; 95% CI, 1.056\u20101.663;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a00.040) was independently associated with rebleeding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After salvage TIPS, 6\u2010week mortality remains high and can be predicted by MELD score and lactate. Survival rate at 6\u00a0weeks was &gt;85% in patients with arterial lactate \u22642.5\u00a0mmol\/L and MELD score\u00a0\u2264\u00a015, while mortality was &gt;90% for lactate \u226512\u00a0mmol\/L and\/or MELD score\u00a0\u2265\u00a030.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hep.31913","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T05:11:58Z","timestamp":1621573918000},"page":"2085-2101","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":56,"title":["Combination of Model for End\u2010Stage Liver Disease and Lactate Predicts Death in Patients Treated With Salvage Transjugular Intrahepatic Portosystemic Shunt for Refractory Variceal Bleeding"],"prefix":"10.1097","volume":"74","author":[{"given":"Aur\u00e9lie","family":"Walter","sequence":"first","affiliation":[{"name":"Service d\u2019H\u00e9patologie,H\u00f4pital Avicenne,H\u00f4pitaux universitaires Paris\u2010Seine\u2010Saint\u2010Denis,Assistance\u2010publique H\u00f4pitaux de Paris,Universit\u00e9 Sorbonne Paris Nord,Bobigny,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika","family":"Rudler","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9pato\u2010gastro\u2010ent\u00e9rologie,H\u00f4pital de la Piti\u00e9\u2010Salp\u00e9tri\u00e8re,H\u00f4pitaux universitaires Piti\u00e9\u2010Salp\u00e9tri\u00e8re\u2010Charles Foix,Assistance\u2010publique H\u00f4pitaux de Paris,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pol","family":"Olivas","sequence":"additional","affiliation":[{"name":"Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic,Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),University of Barcelona,Barcelona,Spain"},{"name":"Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN\u2010Liver),Madrid,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd),Instituto de Salud Carlos III,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucile","family":"Moga","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9patologie,H\u00f4pital Beaujon,H\u00f4pitaux universitaires Paris\u2010Nord\u2010Val\u2010de\u2010Seine,Assistance\u2010publique H\u00f4pitaux de Paris,Clichy,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Tr\u00e9po","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology,CUB H\u00f4pital Erasme,Universit\u00e9 Libre de Bruxelles,Brussels,Belgium"},{"name":"Laboratory of Experimental Gastroenterology,Universit\u00e9 Libre de Bruxelles,Brussels,Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Ang\u00e8le","family":"Robic","sequence":"additional","affiliation":[{"name":"Service d'h\u00e9pato\u2010gastro\u2010ent\u00e9rologie,CHU Toulouse,Toulouse,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Ollivier\u2010Hourmand","sequence":"additional","affiliation":[{"name":"Service d\u2019h\u00e9pato\u2010gastroent\u00e9rologie et de nutrition,CHU C\u00f4te de Nacre,Caen,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Baiges","sequence":"additional","affiliation":[{"name":"Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic,Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),University of Barcelona,Barcelona,Spain"},{"name":"Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN\u2010Liver),Madrid,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd),Instituto de Salud Carlos III,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2802-9652","authenticated-orcid":false,"given":"Olivier","family":"Sutter","sequence":"additional","affiliation":[{"name":"Service de Radiologie,H\u00f4pital Jean Verdier,H\u00f4pitaux universitaires Paris\u2010Seine\u2010Saint\u2010Denis,Assistance\u2010publique H\u00f4pitaux de Paris,Bondy,France"},{"name":"Unit\u00e9 de Formation et de Recherche Sant\u00e9 M\u00e9decine et Biologie Humaine,Universit\u00e9 Paris 13,Communaut\u00e9 d'universit\u00e9s et \u00e9tablissements Sorbonne Paris cit\u00e9,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Bouzbib","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9pato\u2010gastro\u2010ent\u00e9rologie,H\u00f4pital de la Piti\u00e9\u2010Salp\u00e9tri\u00e8re,H\u00f4pitaux universitaires Piti\u00e9\u2010Salp\u00e9tri\u00e8re\u2010Charles Foix,Assistance\u2010publique H\u00f4pitaux de Paris,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Marie","family":"Peron","sequence":"additional","affiliation":[{"name":"Service d'h\u00e9pato\u2010gastro\u2010ent\u00e9rologie,CHU Toulouse,Toulouse,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Le Pennec","sequence":"additional","affiliation":[{"name":"Service de radiologie,CHU C\u00f4te de Nacre,Caen,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Ganne\u2010Carri\u00e9","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9patologie,H\u00f4pital Avicenne,H\u00f4pitaux universitaires Paris\u2010Seine\u2010Saint\u2010Denis,Assistance\u2010publique H\u00f4pitaux de Paris,Universit\u00e9 Sorbonne Paris Nord,Bobigny,France"},{"name":"Unit\u00e9 mixte de Recherche 1138,\u00c9quipe FunGeS,Institut National de la Sant\u00e9 et de la Recherche m\u00e9dicale,Centre de Recherche des Cordeliers,Universit\u00e9 de Paris,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9032-4954","authenticated-orcid":false,"given":"Juan Carlos","family":"Garcia\u2010Pag\u00e1n","sequence":"additional","affiliation":[{"name":"Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic,Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),University of Barcelona,Barcelona,Spain"},{"name":"Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN\u2010Liver),Madrid,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd),Instituto de Salud Carlos III,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Mallet","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9pato\u2010gastro\u2010ent\u00e9rologie,H\u00f4pital de la Piti\u00e9\u2010Salp\u00e9tri\u00e8re,H\u00f4pitaux universitaires Piti\u00e9\u2010Salp\u00e9tri\u00e8re\u2010Charles Foix,Assistance\u2010publique H\u00f4pitaux de Paris,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3216-7692","authenticated-orcid":false,"given":"H\u00e9l\u00e8ne","family":"Larrue","sequence":"additional","affiliation":[{"name":"Service d'h\u00e9pato\u2010gastro\u2010ent\u00e9rologie,CHU Toulouse,Toulouse,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thong","family":"Dao","sequence":"additional","affiliation":[{"name":"Service d\u2019h\u00e9pato\u2010gastroent\u00e9rologie et de nutrition,CHU C\u00f4te de Nacre,Caen,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Thabut","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9pato\u2010gastro\u2010ent\u00e9rologie,H\u00f4pital de la Piti\u00e9\u2010Salp\u00e9tri\u00e8re,H\u00f4pitaux universitaires Piti\u00e9\u2010Salp\u00e9tri\u00e8re\u2010Charles Foix,Assistance\u2010publique H\u00f4pitaux de Paris,Paris,France"},{"name":"Unit\u00e9 mixte de Recherche S 938,Institut National de la Sant\u00e9 et de la Recherche m\u00e9dicale\/CDR Saint\u2010Antoine & Institute of Cardiometabolism and Nutrition,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Hern\u00e1ndez\u2010Gea","sequence":"additional","affiliation":[{"name":"Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic,Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS),University of Barcelona,Barcelona,Spain"},{"name":"Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN\u2010Liver),Madrid,Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd),Instituto de Salud Carlos III,Madrid,Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Charles","family":"Nault","sequence":"additional","affiliation":[{"name":"Service d\u2019H\u00e9patologie,H\u00f4pital Avicenne,H\u00f4pitaux universitaires Paris\u2010Seine\u2010Saint\u2010Denis,Assistance\u2010publique H\u00f4pitaux de Paris,Universit\u00e9 Sorbonne Paris Nord,Bobigny,France"},{"name":"Unit\u00e9 mixte de Recherche 1138,\u00c9quipe FunGeS,Institut National de la Sant\u00e9 et de la Recherche m\u00e9dicale,Centre de Recherche des Cordeliers,Universit\u00e9 de Paris,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Bureau","sequence":"additional","affiliation":[{"name":"Service d'h\u00e9pato\u2010gastro\u2010ent\u00e9rologie,CHU Toulouse,Toulouse,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon","family":"Allaire","sequence":"additional","affiliation":[{"name":"Service d\u2019h\u00e9pato\u2010gastroent\u00e9rologie et de nutrition,CHU C\u00f4te de Nacre,Caen,France"},{"name":"Unit\u00e9 mixte de Recherche 1149,Centre de Recherche sur l\u2019inflammation,Facult\u00e9 de M\u00e9decine Bichat,Paris,France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Salvage TIPS Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,7,19]]},"reference":[{"key":"hep31913-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.jhep.2005.05.009","article-title":"Evolving consensus in portal hypertension. Report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertension","volume":"43","year":"2005","journal-title":"J Hepatol"},{"key":"hep31913-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.jhep.2015.05.022","article-title":"Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension","volume":"63","year":"2015","journal-title":"J Hepatol"},{"key":"hep31913-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1016\/j.jhep.2010.06.004","article-title":"Revising consensus in portal hypertension: report of the Baveno V Consensus Workshop on methodology of diagnosis and therapy in portal hypertension","volume":"53","year":"2010","journal-title":"J Hepatol"},{"key":"hep31913-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1002\/bjs.1800810922","article-title":"Emergency 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Hepatol"},{"key":"hep31913-bib-0011-20250824","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/S0168-8278(01)00185-4","article-title":"Salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding in patients with decompensated cirrhosis","volume":"35","year":"2001","journal-title":"J Hepatol"},{"key":"hep31913-bib-0012-20250824","doi-asserted-by":"crossref","first-page":"481","DOI":"10.3348\/kjr.2009.10.5.481","article-title":"Prediction of mortality after emergent transjugular intrahepatic portosystemic shunt placement: use of APACHE II, Child\u2010Pugh and MELD scores in Asian patients with refractory variceal hemorrhage","volume":"10","year":"2009","journal-title":"Korean J Radiol"},{"key":"hep31913-bib-0013-20250824","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s11547-011-0682-9","article-title":"Emergency transjugular intrahepatic portosystemic shunt (TIPS): results, complications and predictors of mortality in the first 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