Relation Between Pre and Post TIPS Procalcitonin Levels And Early TIPS Occlusion In Budd Chiari Patients

Abstract

TIPS is used as the most common line of treatment in treating BCS patients with good outcome in case of good patient selection. Despite the long-time of experience through this technique, there are predictable complications following and during the maneuver ranging from stent occlusion, sepsis and bleeding up to death. Procalcitonin has been used as a marker for bacterial infection. Lot of studies have been supported its use in patients who have been suspected to have sepsis or infection. This study was a pilot exploratory study carried out on thirty patients with Budd Chiari syndrome who underwent TIPS Procedure. Patients were selected from those presented to The Egyptian Society for Studying of Vascular Liver Disorders, Tropical medicine department, Ain Shams University Hospitals. The aims of this study were to determine the correlation between pre-TIPS serum procalcitonin level (as a marker of infection) and early occlusion of TIPS shunt in patients with Budd Chiari syndrome and also, to determine the correlation between the post TIPS serum procalcitonin level and blood culture results and early TIPS shunt occlusion. The current study was a prospective interventional study. The included patients were BCS patients fit for TIPS without any contraindications for the procedure after full clinical and laboratory investigations, according to the followed international guidelines. Duplex ultrasound testing the stent patency was done at days (0,2,7,14). CBC, Procalcitonin, CRP and blood culture were also withdrawn pre, two days and two weeks post TIPS or at time of stent occlusion (if occurred). Thirty BCS patients underwent TIPS .Females were 63.3% in the studied population. The prevalent thrombophilia etiology in the studied group was MTHFRD (40%) followed by FVLM (36.3%). Hypercoagulable status etiology could not be reached in five patients. Twenty five patients only reached two weeks post TIPS point. One patient died from septicemia one week post TIPS. Four patients developed stent occlusion two days post TIPS. The primary patency of the TIPS stent was achieved in about 76.6% of patients two weeks after TIPS. Procedure related intraperitoneal bleeding occurred in only three patients which required surgical intervention. After analyzing the results we found that there was both high sensitivity and specificity for Procalcitonin assay in detection of blood culture positive results. That was found in pre and two weeks post TIPS or at time of stent occlusion. When we applied the cut off procalcitonin level 0.11 ng/ml, before and two weeks post TIPS or at time of stent occlusion. The sensitivity and specificity were 100%, 96.15% respectively. Those values were relatively higher than the other tested infection biomarkers like CRP,ESR and leucocytic count . Also, we found a relation between the procalcitonin level and the patency of the stent post TIPS. Procalcitonin serum levels were elevated in occluded stent group when compared to patent one two days and two weeks post TIPS or at time of stent occlusion.