Factor VIII/protein C ratio predicts post-TIPS transplantation-free survival

Background and aims Factor VIII/protein C (FVIII/PC) ratio has been shown to be of prognostic relevance in patients with advanced chronic liver disease (ACLD) and it can predict decompensating events. However, its prognostic relevance after resolution of portal hypertension by implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is unkown. Therefore, the aim of this study was to analyze if FVIII/PC can predict further decompensation and mortality after TIPS.

Methods 142 patients with TIPS implantation and measurement of FVIII and PC were included in this study (NCT05782556). Differences between FVIII/PC and the indication for TIPS implantation and its correlation with established prognostic scores were evaluated. The predictive impact of FVIII/PC for predicting further decompensating events after TIPS was evaluated using uni- and multivariable competing-risk and Cox regression models.

Results Median FVIII/PC was 6.1 [4.2-8.6] before TIPS implantation. There were no difiierences between different indications for TIPS implantation (recurrent ascites, secondary prophylaxis of variceal bleeding or pre-emptive TIPS). FVIII/PC was not associated with further decompensation after TIPS implantation (sHR 1.03 [0.98-1.09], p=0.191), development of acute on chronic liver failure (sHR 1.00 [0.93-1.08], p=0.948, persistence of ascites (sHR 1.03 [0.95-1.13], p=0.463 but with hepatic encephalopathy (HE, sHR 1.11 [1.03-1.20], p=0.006) adjusted for the FIPS score. FVIII/PC was also associated with reduced transplantation-free survival (HR 1.10 [1.02-1.20], p=0.013).

Conclusions FVIII/PC is associated with post-TIPS HE and predicts transplantation-free survival. Further, analyses are necessary to assess the pathophysiological links between HE and FVIII/PC.

Publication History

Article published online:
20 January 2025