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TIPS May Reduce Systemic Inflammation, New Research Finds

Patients who received a transjugular intrahepatic portosystemic shunt had reductions in systemic inflammation after placement, according to a study presented at the 2022 International Liver Congress.

Decreasing portal hypertension by inserting a transjugular intrahepatic portosystemic shunt (TIPS) “leads to a significant improvement of [systemic inflammation] over time, which is associated with favorable clinical outcomes,” according to the researchers, led by Benjamin Maasoumy, MD, a gastroenterologist at Hannover Medical School, in Germany.

The investigators evaluated 177 patients who received a TIPS insertion, and evaluated their C-reactive protein (CRP) levels and white blood cell counts at baseline and six, 12, 24 and 36 months after TIPS insertion (abstract FRI485). They also measured levels of 48 cytokines in peripheral blood from 59 patients and five healthy controls; 30 of the cytokines measured were elevated in patients undergoing TIPS. The median age of TIPS patients was 56 years, and the median Model for End-Stage Liver Disease (MELD) score was 12; 76% of patients underwent TIPS placement due to refractory ascites.

The investigators found that CRP levels dropped after TIPS placement, but white blood cell counts did not (P<0.001). Decreased CRP levels were significantly associated with improved survival (P=0.012).

One month after TIPS placement, levels of most of the cytokines measured remained at baseline, and a few increased above baseline levels. However, by month 6, the levels of 25 of the cytokines significantly decreased from baseline levels (false discovery rate <0.05), and levels of seven of the 30 cytokines that were elevated in patients before the procedure were no longer significantly different between the TIPS and healthy control groups

The investigators also found that a decrease in the interleukin-6 level was associated with increased grip strength, body mass index and mid-arm muscle circumference.

Commenting on the study, Justin Boike, MD, MPH, a gastroenterologist at Northwestern University Feinberg School of Medicine, in Chicago, commended the investigators for thoroughly documenting potential connections between post-TIPS outcomes and numerous inflammatory markers.

“It is an interesting study that shows there is a decrease in inflammation after TIPS, which ideally would mean that patients experience some recovery from cirrhosis,” Dr. Boike told Gastroenterology & Endoscopy News. “What we don’t yet have is the connection between changes in these inflammatory markers to actual clinical outcomes.”

Of the 177 patients evaluated in the study, it is unclear who—if any—required a liver transplant before the six-month point at which researchers first measured inflammatory markers post-TIPS placement, Dr. Boike noted.

He said patients with sustained inflammation after TIPS may be more likely to require a liver transplant promptly compared with patients whose inflammatory markers subside, who may not need a liver transplant for months or years.

“The next steps would be to see, either before or at the time of TIPS, which patients have inflammatory markers that suggest a higher risk of hepatic decompensation and/or need for transplant,” Dr. Boike said. “It’s another dimension aside from the MELD score that helps us better predict our patient’s course after TIPS.”

He also noted that it is unclear whether inflammatory markers measured in peripheral venous blood, as used in this study, or those found in portal blood are the better indicators for patient prognoses after TIPS.

The study also reflects increased interest in protecting against acute on chronic liver failure, added Dr. Boike, who is part of a team conducting an ongoing five-year registry trial of clinical outcomes after TIPS.

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