Neurofilament Light Chains in Serum Predict Post-Transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy

Hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) insertion constitutes a frequent and severe complication. However, there is a lack of robust predictive biomarkers for post-TIPS HE, so far. This study evaluated the usefulness of neurofilament light chains (NfL) and glial fibrillary acidic protein (GFAP) in serum for predicting post-TIPS HE. Around 144 patients with cirrhosis from three centers were prospectively included and monitored for the occurrence of post-TIPS overt HE, liver transplantation, and death. Serum NfL and GFAP were evaluated before TIPS insertion using the single molecule array technology. In a subgroup of patients sequential NfL and GFAP levels were assessed at 30- and 180-days post-TIPS. While higher NfL levels (sHR 1.01, p = 0.036) were independently associated with post-TIPS OHE after adjusting for other risk factors, GFAP levels had no predictive ability. Consistently, only elevated NfL levels were associated with a higher risk of death/liver transplantation in multivariable analyses. Sequential measurements of NfL at 30 and 180 days after TIPS revealed that NfL levels remain constant until Day 30 followed by a decrease at day 180. Notably, GFAP levels did not change over time. Thus, NfL could be a valuable biomarker for identifying high-risk patients for post-TIPS HE.