High stent shunt flow increases the incidence of overt-hepatic encephalopathy in cirrhotic patients after transjugular intrahepatic portosystemic shunt.

Abstract

Background: The incidence of hepatic encephalopathy (HE) was higher within 1 year after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis. While some findings showed that the shunt flow correlates with HE, it remains unknown whether the stent shunt flow (SSF) is associated with overt-hepatic encephalopathy (OHE). This study, therefore, investigated the association between SSF and OHE after a TIPS.

Methods: A digital color ultrasonic diagnostic device was used to measure stent flow velocity (SFV). The association between SSF and OHE was then examined using logistic regression and restricted cubic spline models. The predictive value of SSF for OHE was also assessed using receiver operating characteristic curve analysis.

Results: Of the 91 patients, 24 (26.4%) developed OHE after TIPS within 1 year. Patients with OHE post-TIPS had higher SSF than those without [2459 (2203-2490) ml/min vs. 2190 (1968-2363) ml/min; P  = 0.001]. Multiple logistic regression showed interquartile range of SSF was associated positively with the risk of OHE after TIPS [odds ratio, 2.483; 95% confidence interval (CI), 1.407-4.383; P  = 0.002]. The Andersen-Gill model indicated SSF [hazard ratio (HR), 1.002; 95% CI, 1.001-1.004; P  < 0.05] and age (HR, 1.042; 95% CI, 1.012-1.072; P  < 0.01) were independent predictors of OHE after TIPS. SSF had higher predictive power for OHE than age, ammonia levels, Child-Pugh score, and model for end-stage liver disease score.

Conclusion: This study suggests high SSF may be associated closely with an increased risk of OHE in patients with cirrhosis following TIPS.