Validation of AMMON-OHE Model for Predicting Overt Hepatic Encephalopathy after Transjugular Intrahepatic...

Area of Science:

• Hepatology
• Gastroenterology
• Clinical Prediction Modeling

Background:

• Transjugular intrahepatic portosystemic shunt (TIPS) creation is a common procedure for managing complications of portal hypertension.
• Overt hepatic encephalopathy (OHE) is a frequent and serious complication following TIPS, impacting patient outcomes.
• Accurate prediction of OHE and its impact on mortality is crucial for patient management.

Purpose of the Study:

• To evaluate the predictive performance of the AMMON-OHE model for overt hepatic encephalopathy (OHE) in patients undergoing TIPS.
• To investigate the prognostic significance of OHE in relation to all-cause mortality within the TIPS cohort.

Main Methods:

• A retrospective analysis of 278 cirrhotic patients who underwent TIPS between 2018 and 2022.
• Development and assessment of AMMON-OHE models using clinical and biochemical data at pre-TIPS, before discharge, and one-month time points.
• Model performance evaluated using integrated Brier scores (IBS), C-index, and decision curve analysis.

Main Results:

• The AMMON-OHE models demonstrated superior prediction of OHE compared to standard liver function scores, with the one-month model showing the best performance (2-yr C-index: 0.7462).
• Key predictors for pre-TIPS OHE included age, diabetes, albumin, and ammonia levels; incorporating age >65 further enhanced predictive accuracy.
• OHE occurrence significantly increased mortality risk (HR: 4.49), particularly early, severe, or recurrent OHE, with risk stratification applicable to mortality prediction.

Conclusions:

• The AMMON-OHE model is a valuable tool for identifying cirrhotic patients at high risk of developing OHE before TIPS placement.
• Post-TIPS OHE is a significant independent predictor of increased all-cause mortality, highlighting the importance of OHE management.