Risk factors for recurrent variceal bleeding after TIPS in cirrhotic patients with esophagogastric variceal hemorrhage: a single-center retrospective study

Abstract

Background Transjugular intrahepatic portosystemic shunt (TIPS) effectively reduces portal pressure but post-procedural rebleeding remains a major clinical challenge. Risk factors for rebleeding are not fully defined. Methods This single-center retrospective cohort study included 114 cirrhotic patients who underwent TIPS for EGVB (2019–2024). Patients were categorized into rebleeding (n = 35) and non-rebleeding (n = 79) groups based on 1-year post-TIPS rebleeding. Clinical, laboratory, procedural, prior endoscopic treatment history and follow-up data were analyzed. Univariate and multivariate Cox proportional hazards models were used to identify risk factors. Cumulative rebleeding incidence was compared between serum sodium groups (<135 vs. ≥135 mmol/L) using Kaplan–Meier analysis with log-rank test. Results The 1-year rebleeding rate was 30.7% (35/114). Multivariate Cox regression identified lower serum sodium (HR = 0.85; 95% CI: 0.77–0.93; P < 0.001) and shunt dysfunction (HR = 4.60; 95% CI: 2.21–9.58; P < 0.001) as independent risk factors for rebleeding. Stent type was not independently associated after adjustment. The low sodium group (<135 mmol/L) showed a significantly higher cumulative rebleeding incidence than the high sodium group (log-rank P = 0.041). Conclusion: Serum sodium preoperatively and post-TIPS shunt dysfunction are independent risk factors for 1-year rebleeding. Optimizing serum sodium preoperatively and implementing regular surveillance for shunt dysfunction may help reduce rebleeding risk in these patients.