Association Between Portosystemic Shunts and Increased Complications and Mortality in Patients With Cirrhosis

Abstract Background & Aims Spontaneous portosystemic shunts (SPSSs) have been associated with hepatic encephalopathy (HE). Little is known about their prevalence among patients with cirrhosis or clinical effects. We investigated the prevalence and characteristics of SPSSs in patients with cirrhosis and their outcomes. Methods We performed a retrospective study of 1729 patients with cirrhosis who underwent abdominal computed tomography or magnetic resonance imaging analysis from 2010 through 2015 at 14 centers in Canada and Europe. We collected data on demographic features, etiology of liver disease, comorbidities, complications, treatments, laboratory and clinical parameters, model for end-stage liver disease (MELD) score, and endoscopy findings. Abdominal images were reviewed by a radiologist (or a hepatologist trained by a radiologist) and searched for the presence of SPSS, defined as spontaneous communications between the portal venous system or splanchnic veins and the systemic venous system, excluding gastroesophageal varices. Patients were assigned to groups with large SPSSs (L-SPSSs, ≥8 mm), small SPSSs (S-SPSSs, Results L-SPSS were identified in 488 patients (28%), S-SPSS in 548 patients (32%), and no shunt (W-SPSS) in 693 patients (40%). The most common L-SPSS was spleno–renal (46% of L-SPSSs). The presence and size of SPSS increased with liver dysfunction: among patients with MELD scores of 6–9, 14% had L-SPSSs and 28% had S-SPSSs; among patients with MELD scores of 10–13, 30% had L-SPSSs and 34% had S-SPSSs; among patients with MELD scores of 14 or more, 40% had L-SPSSs and 32% had S-SPSSs (P Conclusions In a retrospective analysis of almost 2000 patients, we found 60% to have SPSSs; prevalence increases with deterioration of liver function. SPSSs increase risk for HE and chronic course. In patients with preserved liver function, SPSSs increase risk for complications and death. ClincialTrials.gov no: NCT02692430.