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Diabetes Mellitus is a Risk Factor for Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt
Michelle Spaan1,2, Ellen Werner1, Willemijn Dijkstra1
1Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Alimentary Pharmacology & Therapeutics
|November 29, 2025
Summary
Diabetes Mellitus (DM) significantly increases the risk of hepatic encephalopathy (HE) after Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement in cirrhosis patients. This finding is crucial for managing patients with both conditions.
Area of Science:
- Hepatology
- Gastroenterology
- Interventional Radiology
Background:
- Transjugular intrahepatic portosystemic shunt (TIPS) placement is effective for reducing portal pressure in decompensated cirrhosis.
- Hepatic encephalopathy (HE) is a common complication following TIPS procedures.
Purpose of the Study:
- To investigate the association between Diabetes Mellitus (DM) and the incidence of HE post-TIPS in patients with cirrhosis.
- To evaluate DM as an independent risk factor for HE development after TIPS.
Main Methods:
- Retrospective cohort study including 325 cirrhosis patients who underwent TIPS between 2007 and 2021.
- Analysis of baseline characteristics and decompensating events, including hospital admissions for HE.
- Multivariable Cox regression with competing risk analyses to assess risk factors for HE.
Main Results:
- 113 patients (34.8%) had DM at the time of TIPS.
- The cumulative 6-month incidence of HE was 45.2% and severe HE was 25.1%.
- DM was independently associated with an increased risk of both HE (aHR 1.56) and severe HE (aHR 1.76), independent of age and MELD-Na score.
Conclusions:
- DM is a significant and independent risk factor for developing HE after TIPS placement.
- The findings are relevant given the rising prevalence of metabolic dysfunction-associated liver cirrhosis and DM.
- This study provides insights into the risk-benefit balance of TIPS in patients with DM.
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