Overt hepatic encephalopathy after elective and preemptive TIPS: Risk factors and prognosis

Area of Science:

• Hepatology
• Gastroenterology
• Interventional Radiology

Background:

• Overt hepatic encephalopathy (OHE) is a common complication following transjugular intrahepatic portosystemic shunt (TIPS) placement.
• Data on OHE after preemptive TIPS (pTIPS) is limited, necessitating further investigation into its prevalence and risk factors compared to elective TIPS.

Purpose of the Study:

• To assess the prevalence of OHE after pTIPS.
• To compare OHE rates between pTIPS and elective TIPS.
• To identify specific risk factors for OHE in both pTIPS and elective TIPS scenarios.

Main Methods:

• A single-center observational study included 191 patients with cirrhosis undergoing pTIPS or elective TIPS between 2017 and 2023.
• Patient follow-up extended up to one year, or until death or liver transplantation (LT).

Main Results:

• OHE occurred in 41% of pTIPS patients and 38% of elective TIPS patients (p=0.6).
• Risk factors for OHE post-pTIPS included prior cardiac disease and sarcopenia.
• For elective TIPS, baseline ammonia, prior cardiac disease, and albumin levels were associated with OHE.

Conclusions:

• OHE is a frequent complication after both preemptive and elective TIPS, with distinct risk factor profiles.
• Persistent or refractory OHE after TIPS is linked to adverse outcomes, suggesting the need for early liver transplantation evaluation.