Abstract / Summary
Abstract Background : Renal dysfunction is increasingly recognized as an important determinant of prognosis in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS). However, the prognostic value of preprocedural estimated glomerular filtration rate (eGFR) in this setting remains insufficiently defined. This study evaluated the association between preprocedural eGFR and all-cause mortality after covered-stent TIPS. Methods : This single-center retrospective cohort study included patients with cirrhosis who underwent first-time covered-stent TIPS between January 2015 and January 2024. Preprocedural eGFR was calculated using the CKD-EPI 2021 creatinine-based equation and categorized as ≥ 90, 60–89, or < 60 mL/min/1.73 m². Survival was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Restricted cubic spline analysis was used to examine the dose–response relationship between eGFR and mortality. Sensitivity analyses were performed by additionally adjusting for the MELD score and by modeling eGFR as a continuous variable. Results : Among 618 patients, 146 died during a median follow-up of 36.5 months. Compared with eGFR ≥ 90 mL/min/1.73 m², eGFR < 60 mL/min/1.73 m² was associated with higher all-cause mortality after adjustment for age, serum sodium, and Child–Pugh score (HR = 2.21, 95% CI 1.39–3.53, P < 0.001), whereas eGFR 60–89 mL/min/1.73 m² was not significantly associated with mortality after adjustment. After additional adjustment for MELD score, the association for eGFR < 60 mL/min/1.73 m² was attenuated (HR = 1.63, 95% CI 0.95–2.80, P = 0.078). When modeled continuously, each 1 mL/min/1.73 m² increase in eGFR was associated with lower mortality risk (HR = 0.989, 95% CI 0.981–0.996, P = 0.004). Lower eGFR was also associated with higher proportions of hepatic encephalopathy and worsening ascites. Conclusions : Preprocedural eGFR < 60 mL/min/1.73 m² was associated with increased all-cause mortality after covered-stent TIPS in the primary model, although this association was attenuated after MELD adjustment. Preprocedural eGFR may serve as a practical reference marker for comprehensive pre-TIPS risk assessment, but should not be interpreted as a standalone prognostic criterion. Multicenter prospective validation is warranted.