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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 1/2024

05-10-2023 | Hepatic Encephalopathy | Clinical Investigation

Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS?

Authors: Pooya Torkian, Stephanie Wallace, Nicholas Lim, Siobhan Flanagan, Jafar Golzarian, Shamar J. Young

Published in: CardioVascular and Interventional Radiology | Issue 1/2024

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Abstract

Purpose

To evaluate the impact of pre-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) on developing post-TIPS HE.

Materials and Methods

In this retrospective, single center observational study, all patients who underwent successful TIPS placement between January 2005 and May 2020 with data pertaining to HE in their chart were included. Patient demographics and procedural details were recorded. Clinical outcomes post-TIPS, were collected and compared across patients with and without pre-TIPS HE.

Results

Of 326 included patients, 159 (159/326, 48.8%) had a history of pre-TIPS HE. In total those without a history of HE were more likely to develop HE during follow up (136 (136/167, 81.4%) vs 107 (107/159, 67.3%), p = 0.001). When evaluating for predictors of developing HE within 3 months of TIPS placement, no significant variables were found on logistic regression, including prior history of HE (HR 1.16 (95% CI 0.73–1.84), p = 0.529). Univariate and multivariate regression analysis, however, showed that a history of HE was predictive of developing HE at any point in the follow-up period (p = 0.002 and p = 0.008, respectively). However, on Kaplan–Meier analysis no significant difference in the development of HE (p = 0.574) or hospital admission for HE (p = 0.554) post-TIPS was seen between patients with and without pre-TIPS HE. Additionally, there was no difference in 3-month survival (p = 0.412) or overall survival post-TIPS survival (p = 0.798).

Conclusion

Pre-TIPS HE did not predict the development of HE within 3 months of TIPS. Outcomes such as hospital admission and survivability were not different between patients with and without prior HE.
Literature
1.
Strunk H, Marinova M. Transjugular intrahepatic portosystemic shunt (TIPS): pathophysiologic basics, actual indications and results with review of the literature. RöFo - Fortschritte Auf Dem Geb Röntgenstrahlen Bildgeb Verfahr. 2018;190(08):701–11.CrossRef
2.
Schindler P, Heinzow H, Trebicka J, Wildgruber M. Shunt-Induced hepatic encephalopathy in TIPS: current approaches and clinical challenges. J Clin Med. 2020;9(11):3784.CrossRefPubMedPubMedCentral
3.
Saab S, Kim NG, Lee EW. Practical tips on TIPS: when and when not to request it. Off J Am Coll Gastroenterol ACG. 2020;115(6):797–800.CrossRef
4.
García-Pagán JC, Caca K, Bureau C, Laleman W, Appenrodt B, Luca A, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 2010;362(25):2370–9.CrossRefPubMed
5.
Yao J, Zuo L, An G, Yue Z, Zhao H, Wang L, Liu F, et al. Risk factors for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma and portal hypertension. J Gastrointestin Liver Dis. 2015;24(3):301–7.CrossRefPubMed
6.
Saab S, Zhao M, Asokan I, Yum JJ, Lee EW. History of hepatic encephalopathy is not a contraindication to transjugular intrahepatic portosystemic shunt placement for refractory ascites. Clin Transl Gastroenterol. 2021;12(8):e00378.CrossRefPubMedPubMedCentral
7.
Dariushnia SR, Haskal ZJ, Midia M, Martin LG, Walker TG, Kalva SP, et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunts. J Vasc Interv Radiol. 2016;27(1):1–7.CrossRefPubMed
8.
Rowley MW, Choi M, Chen S, Hirsch K, Seetharam AB. Refractory hepatic encephalopathy after elective transjugular intrahepatic portosystemic shunt: risk factors and outcomes with revision. Cardiovasc Intervent Radiol. 2018;41(11):1765–72.CrossRefPubMed
9.
Casadaban LC, Parvinian A, Minocha J, Lakhoo J, Grant CW, Ray CE, et al. Clearing the confusion over hepatic encephalopathy after TIPS creation: incidence, prognostic factors, and clinical outcomes. Dig Dis Sci. 2015;60(4):1059–66.CrossRefPubMed
10.
Yang Y, Fu S, Cao B, Hao K, Li Y, Huang J, et al. Prediction of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt treatment: a cohort study. Hepatol Int. 2021;15(3):730–40.CrossRefPubMed
11.
Li Y, He X, Pang H. A model to predict early hepatic encephalopathy in patients undergoing transjugular intrahepatic portosystemic shunt. Turk J Gastroenterol. 2019;30(8):702–7.CrossRefPubMed
12.
Tong H, Gan C, Wei B, Wang ZD, Li XD, Qian SJ, et al. Risk factors for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation in patients with liver cirrhosis. J Dig Dis. 2021;22(1):31–40.CrossRefPubMed
13.
Yin X, Zhang F, Guo H, Peng C, Zhang W, Xiao J, et al. A nomogram to predict the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients. Sci Rep. 2020;10(1):9381.CrossRefPubMedPubMedCentral
14.
Coronado WM, Ju C, Bullen J, Kapoor B. Predictors of occurrence and risk of hepatic encephalopathy after TIPS creation: a 15-year experience. Cardiovasc Intervent Radiol. 2020;43(8):1156–64.CrossRefPubMed
15.
Liu J, Zhou C, Wang Y, Yang C, Shi Q, Huang S, et al. The combination of Child-Pugh score and quantitative CT-based spleen volume could predict the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation. Abdom Radiol. 2021;46(7):3464–70.CrossRef
16.
Lin X, Gao F, Wu X, Cai W, Chen X, Huang Z. Efficacy of albumin–bilirubin score to predict hepatic encephalopathy in patients underwent transjugular intrahepatic portosystemic shunt. Eur J Gastroenterol Hepatol. 2021;33(6):862–71.CrossRefPubMed
17.
Yin X, Zhang F, Xiao J, Wang Y, He Q, Zhu H, et al. Diabetes mellitus increases the risk of hepatic encephalopathy after a transjugular intrahepatic portosystemic shunt in cirrhotic patients. Eur J Gastroenterol Hepatol. 2019;31(10):1264–9.CrossRefPubMed
18.
Nardelli S, Lattanzi B, Torrisi S, Greco F, Farcomeni A, Gioia S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol. 2017;15(6):934–6.CrossRefPubMed
19.
Nazarian GK, Ferral H, Bjarnason H, Castañeda-Zúñiga WR, Rank JM, Bernadas CA, et al. Effect of transjugular intrahepatic portosystemic shunt on quality of life. Am J Roentgenol. 1996;167(4):963–9.CrossRef
20.
Ballester MP, Lluch P, Gómez C, Capilla M, Tosca J, Martí-Aguado D, et al. Transjugular intrahepatic portosystemic shunt reduces hospital care burden in patients with decompensated cirrhosis. Intern Emerg Med. 2021;16(6):1519–27.CrossRefPubMed
21.
Leise MD, Kim WR, Kremers WK, Larson JJ, Benson JT, Therneau TM. A revised model for end-stage liver disease optimizes prediction of mortality among patients awaiting liver transplantation. Gastroenterology. 2011;140(7):1952–60.CrossRefPubMed
22.
Routhu M, Safka V, Routhu SK, Fejfar T, Jirkovsky V, Krajina A, et al. Observational cohort study of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS). Ann Hepatol. 2017;16(1):140–8.CrossRefPubMed
23.
Bai M, Qi X, Yang Z, Yin Z, Nie Y, Yuan S, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review: predictors of HE after TIPS. J Gastroenterol Hepatol. 2011;26(6):943–51.CrossRefPubMed
24.
Riggio O, Masini A, Efrati C, Nicolao F, Angeloni S, Salvatori FM, et al. Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: a randomized controlled study. J Hepatol. 2005;42(5):674–9.CrossRefPubMed
25.
Masson S, Mardini HA, Rose JD, Record CO. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt insertion: a decade of experience. QJM. 2008;101(6):493–501.CrossRefPubMed
Metadata
Title
Pre-existing Hepatic Encephalopathy: Really a Contraindication to Elective TIPS?
Authors
Pooya Torkian
Stephanie Wallace
Nicholas Lim
Siobhan Flanagan
Jafar Golzarian
Shamar J. Young
Publication date
05-10-2023
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 1/2024
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-023-03566-z

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