{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:48:35Z","timestamp":1785473315626,"version":"3.56.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,8,12]],"date-time":"2022-08-12T00:00:00Z","timestamp":1660262400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Ascites is a definitive sign of decompensated liver cirrhosis driven by portal hypertension. Although transjugular intrahepatic portosystemic shunt insertion (TIPS) is indicated for therapy of recurrent and refractory ascites, there is no evidence\u2010based recommendation for a specific target of portal hepatic pressure gradient (PPG) decrease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>In this single\u2010center, retrospective trial, we investigated the decrease of PPG in 341 patients undergoing TIPS insertion for therapy of refractory or recurrent ascites until 2015. During each procedure, portal and inferior vena cava pressures were invasively measured and correlated with patients' outcome and ascites progression over time, according to the prespecified Noninvasive Evaluation Program for TIPS and Follow\u2010Up Network protocol (NCT03628807).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Patients without ascites at 6\u2009weeks after TIPS had significantly greater PPG reduction immediately after TIPS, compared to the patients with refractory ascites (median reduction 65% vs. 55% of pre\u2010TIPS PPG; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.001). Survival was significantly better if ascites was controlled, compared to patients with need for paracentesis 6\u2009weeks after TIPS (median survival: 185 vs. 41\u2009weeks; HR 2.0 [1.3\u20132.9]; <jats:italic toggle=\"yes\">p<\/jats:italic>\u2009&lt;\u20090.001). Therefore, higher PPG reduction by TIPS (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.005) and lower PPG after TIPS (<jats:italic toggle=\"yes\">p<\/jats:italic> = 0.02) correlated with resolution of severe ascites 6\u2009weeks after TIPS. Multivariable analyses demonstrated that higher Child\u2010Pugh score before TIPS (OR 1.3 [1.0\u20131.7]; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.03) and lower serum sodium levels (OR 0.9 [0.9\u20131.0]; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.004) were independently associated with ascites persistence 6\u2009weeks after TIPS, whereas PPG reduction (OR 0.98 [0.97\u20131.00]; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.02) was associated with resolution of ascites 6\u2009weeks after TIPS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>Extent of PPG reduction and\/or lowering of target PPG immediately after TIPS placement is associated with improved ascites control in the short term and with survival in the long term. A structured follow\u2010up visit for patients should assess persistence of ascites at 6\u2009weeks after TIPS.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.32676","type":"journal-article","created":{"date-parts":[[2022,7,23]],"date-time":"2022-07-23T04:54:35Z","timestamp":1658552075000},"page":"466-475","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":30,"title":["Targeted decrease of portal hepatic pressure gradient improves ascites control after TIPS"],"prefix":"10.1097","volume":"77","author":[{"given":"Alexander","family":"Queck","sequence":"first","affiliation":[{"name":"Department of Internal Medicine 1, University Hospital Frankfurt, Johann Wolfgang Goethe\u2010University, Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Schwierz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyi","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 1, University Hospital Frankfurt, Johann Wolfgang Goethe\u2010University, Frankfurt am Main, Germany"},{"name":"Department of Internal Medicine B, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip G.","family":"Ferstl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 1, University Hospital Frankfurt, Johann Wolfgang Goethe\u2010University, Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank E.","family":"Uschner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 1, University Hospital Frankfurt, Johann Wolfgang Goethe\u2010University, Frankfurt am Main, Germany"},{"name":"Department of Internal Medicine B, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7033-9956","authenticated-orcid":false,"given":"Michael","family":"Praktiknjo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany"},{"name":"Department of Internal Medicine B, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian J.","family":"Brol","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 1, University Hospital Frankfurt, Johann Wolfgang Goethe\u2010University, Frankfurt am Main, Germany"},{"name":"Department of Internal Medicine B, University of M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Schepis","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Azienda Ospedaliero\u2010Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3173-9767","authenticated-orcid":false,"given":"Manuela","family":"Merli","sequence":"additional","affiliation":[{"name":"Gastroenterology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian 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