Liver Failure and Liver Disease

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Quality of life in refractory ascites: Transjugular intrahepatic portal-systemic shunting versus medical therapy†

  1. Mical S. Campbell1,
  2. Colleen M. Brensinger2,
  3. Arun J. Sanyal3,
  4. Chris Gennings4,
  5. Florence Wong5,
  6. Kris V. Kowdley6,
  7. Timothy McCashland7,
  8. K. Rajender Reddy1,‡,*

Article first published online: 17 AUG 2005

DOI: 10.1002/hep.20840

Issue

Hepatology

Hepatology

Volume 42, Issue 3, pages 635–640, September 2005

Additional Information

How to Cite

Campbell, M. S., Brensinger, C. M., Sanyal, A. J., Gennings, C., Wong, F., Kowdley, K. V., McCashland, T. and Reddy, K. R. (2005), Quality of life in refractory ascites: Transjugular intrahepatic portal-systemic shunting versus medical therapy. Hepatology, 42: 635–640. doi: 10.1002/hep.20840

Author Information

  1. 1

    Division of Gastroenterology, University of Pennsylvania Health Services, Philadelphia, PA

  2. 2

    Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA

  3. 3

    Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA

  4. 4

    Department of Biostatistics, Virginia Commonwealth University, Richmond, VA

  5. 5

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

  6. 6

    Department of Internal Medicine, University of Washington, Seattle, WA

  7. 7

    Department of Internal Medicine, University of Nebraska, Omaha, NE

  1. ‡

    fax: (215) 349-5915

*Division of Gastroenterology, 3 Ravdin, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104

  1. †

    Potential conflict of interest: Nothing to report.

Publication History

  1. Issue published online: 22 AUG 2005
  2. Article first published online: 17 AUG 2005
  3. Manuscript Accepted: 21 JUN 2005
  4. Manuscript Received: 30 MAR 2005

Funded by

  • National Institutes of Health. Grant Numbers: R01 DK 51523, M01-RR-00065

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Abstract

Uncontrolled studies suggest that transjugular intrahepatic portal-systemic shunting (TIPS) may improve quality of life in patients with refractory ascites. We hypothesized that any improvement of quality of life in patients with TIPS would be matched in controls due to the competing effects of improved ascites and worsened hepatic encephalopathy. Thus, an analysis of quality of life was performed using original data from the North American Study for the Treatment of Refractory Ascites, a multicenter trial of 109 patients randomized to TIPS or repeated large volume paracentesis (LVP) for refractory ascites. Short form 36 (SF-36) surveys were completed at baseline and at 6- and 12-month follow-up. Variables analyzed were: randomization group, number of LVP performed, cumulative volume from LVP, shortness of breath, abdominal distention, abdominal pain, diuretic usage, confusion, hospitalizations, and emergency room visits. Outcomes were changes in physical component scale (PCS) and mental component scale (MCS) of SF-36 results. We constructed multivariable, mixed effects models, including randomization group and baseline MCS and PCS. Changes in PCS and MCS from baseline were similar between the two randomization groups. In multivariate analysis, PCS improvement was associated with lack of confusion, improved ascites, and lack of hospitalizations, but not directly with randomization group. Improvement in MCS was associated with randomization to TIPS and lack of confusion. In conclusion, patients with refractory ascites randomized to TIPS or repeated LVP had similar changes in quality of life. Competing effects of hepatic encephalopathy, requirement for repeated LVP, and need for hospitalizations explain similar changes in quality of life between the two groups. (HEPATOLOGY 2005.)

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