{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T11:27:48Z","timestamp":1789817268230,"version":"4.0.1"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension\u2010related complications. However, careful selection of patients is crucial. The aim of this study was to evaluate the prognostic value of serum cholinesterase (CHE) for outcomes and mortality after TIPS insertion. In this multicenter study, 389 consecutive patients with cirrhosis receiving a TIPS at Hannover Medical School, University Hospital Essen, or Medical University of Vienna were included. The Hannover cohort (n = 200) was used to initially explore the role of CHE, whereas patients from Essen and Vienna served as a validation cohort (n = 189). Median age of the patients was 58 years and median Model for End\u2010Stage Liver Disease (MELD) score was 12. Multivariable analysis identified MELD score (hazard ratio [HR]: 1.16; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) and CHE (HR: 0.61; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.008) as independent predictors for 1\u2010year survival. Using the Youden Index, a CHE of 2.5 kU\/L was identified as optimal threshold to predict post\u2010TIPS survival in the Hannover cohort (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001), which was confirmed in the validation cohort (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.010). CHE\u00a0&lt;\u00a02.5 kU\/L was significantly associated with development of acute\u2010on\u2010chronic liver failure (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) and hepatic encephalopathy (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.006). Of note, CHE was also significantly linked to mortality in the subgroup of patients with refractory ascites (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.001) as well as in patients with high MELD scores (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.012) and with high\u2010risk FIPS scores (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.004). After propensity score matching, mortality was similar in patients with ascites and CHE\u00a0&lt;\u00a02.5 kU\/L if treated by TIPS or by paracentesis. Contrarily, in patients with CHE\u00a0\u2265\u00a02.5 kU\/L survival was significantly improved by TIPS as compared to treatment with paracentesis (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> CHE is significantly associated with mortality and complications after TIPS insertion. Therefore, we suggest that CHE should be evaluated as an additional parameter for selecting patients for TIPS implantation.<\/jats:p>","DOI":"10.1002\/hep4.1829","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T03:40:05Z","timestamp":1632886805000},"page":"621-632","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Low Serum Cholinesterase Identifies Patients With Worse Outcome and Increased Mortality After TIPS"],"prefix":"10.1097","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8453-8603","authenticated-orcid":false,"given":"Lena","family":"Stockhoff","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Endocrinology,Hannover Medical 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