Association of Preprocedural Indocyanine Green Retention With 90-Day Outcomes After TIPS: A Single-Center Retrospective Cohort Study
This single-center retrospective study found that preprocedural indocyanine green retention at 15 minutes (ICG-R15) was not independently associated with a strict 90-day composite outcome and failed to improve risk prediction beyond a parsimonious clinical model for patients undergoing TIPS.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the complex world of liver medicine, doctors often face a difficult balancing act when treating patients with dangerously high blood pressure in the veins that feed the liver. This condition, known as portal hypertension, can cause life-threatening bleeding or severe fluid buildup in the belly. To relieve this pressure, specialists perform a procedure called a transjugular intrahepatic portosystemic shunt, or TIPS. It involves threading a small tube through a vein in the neck to create a new channel inside the liver, allowing blood to bypass the blockage. While this can be a lifesaving fix, it carries significant risks. The liver is a delicate organ, and altering its blood flow can sometimes trigger confusion, lead to organ failure, or result in death within the first few months after the procedure. Before deciding who is safe enough to undergo this surgery, doctors need a way to predict how well a specific patient's liver will handle the stress. They currently rely on standard scores based on blood test results and age, but these are static snapshots that do not capture how the liver actually functions in real time.
To find a better way to predict outcomes, researchers at Beijing Shijitan Hospital looked at a dynamic test called indocyanine green retention. This test involves injecting a harmless green dye into a patient's bloodstream and measuring how much of it remains in the blood after fifteen minutes. Because the liver is responsible for clearing this dye, the amount left behind offers a glimpse into the organ's current ability to process substances, reflecting blood flow and cell health. The team wondered if this dynamic measure, taken before the surgery, could predict who would suffer serious complications within ninety days. They wanted to know if adding this single test to the standard clinical picture would help doctors make safer, more accurate decisions about who should receive the TIPS procedure.
The researchers examined the records of 193 adults who had successfully undergone the TIPS procedure at their hospital between 2019 and 2020. They focused on a strict definition of a bad outcome, which included death, the need for a liver transplant, confirmed severe confusion caused by the liver, a return to the hospital specifically for liver problems, or a specific type of liver dysfunction detected by blood tests around two weeks after the surgery. In total, 27 of the 193 patients, or about 14 percent, experienced one of these serious events within the first ninety days. The team then compared the standard prediction model, which used the patient's age, a severity score based on blood work, and the reason for the surgery, against a new model that also included the green dye retention percentage.
The results were clear and somewhat surprising. The study found that the amount of green dye remaining in the blood was not an independent predictor of these serious complications. When the researchers added the dye test results to their prediction model, it did not improve their ability to distinguish between patients who would do well and those who would not. In fact, the statistical measure of how well the model performed actually dipped slightly when the dye test was included, suggesting that the extra information did not add value and might have even introduced noise. The standard model, relying on age, blood test severity, and the reason for the surgery, performed just as well on its own. Even when the researchers adjusted their analysis to include patients with less clearly documented hospital returns, or looked only at patients with confirmed cirrhosis, the green dye test still failed to show a reliable link to the outcomes.
This study does not suggest that the liver's ability to clear dye is unimportant biologically; rather, it indicates that this specific test, as currently used, does not offer a practical advantage over existing tools for predicting short-term risks before this surgery. The researchers emphasized that their findings were based on a single hospital's data and a relatively small number of serious events, which means the results need to be confirmed by other groups in different settings before any changes are made to clinical practice. For now, the evidence does not support using this dynamic dye test to routinely decide which patients should or should not receive the TIPS procedure. The standard clinical assessment remains the most reliable guide for these critical decisions, and the search for a better predictor continues.
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