Risk factors for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation in liver cirrhosis patients.

AIMS Overt hepatic encephalopathy (OHE) occurred commonly after transjugular intrahepatic portosystemic shunt (TIPS). Evaluating the variables comprehensively, this retrospective cohort study aimed to determine post-TIPS OHE risk factors and establish a risk score to evaluate the risk better. METHODS From January 2015 to March 2018, 299 and 62 liver cirrhosis patients receiving TIPS were included into the derivation and validation cohorts, respectively. In the derivation cohort, data were drawn for analyses on post-TIPS OHE risk factors. Risk score was established to evaluate post-TIPS OHE risk, and it was further validated by the validation cohort. RESULTS During the median follow-up of 112.6 weeks in the derivation cohort, 52 (17.4%) patients experienced post-TIPS OHE. Logistic regression showed that alcoholic cirrhosis (OR: 3.068, 95% CI: [1.423-6.613]; p=0.004), stent diameter (12.046 [2.308-62.862]; p=0.003), portal pressure gradient (PPG) decrement percentage ≥60% (3.548 [1.741-7.230]; p<0.001), MELD score ≥10 (2.695 [1.203-6.035]; p=0.016), blood ammonia (1.009 [1.000-1.018]; p=0.043), and remarkable hydrothorax (4.393 [1.554-12.415]; p=0.005) increased post-TIPS OHE risk. The risk score established from the derivation cohort was tested in the validation cohort, reaching the sensitivity of 71.4%, specificity of 70.7%, and accuracy of 71.0% to evaluate post-TIPS OHE risk. CONCLUSIONS Alcoholic cirrhosis and remarkable hydrothorax contribute to be the independent risk factors of post-TIPS OHE in liver cirrhosis patients, together with stent diameter, PPG decrement percentage ≥60%, MELD score ≥10 and blood ammonia. Risk score composed of these risk factors is helpful to discriminating the high post-TIPS OHE risk individuals from TIPS candidates with the acceptable efficacy. This article is protected by copyright. All rights reserved.