経皮的肝内門脈-体循環シャント術後の顕性肝性脳症予測のためのAMMON-OHEモデルの検証

To explore the predictive performance of AMMON-OHE model in transjugular intrahepatic portosystemic shunt (TIPS) cohort and explore the prognostic relevance between overt hepatic encephalopathy(OHE) and all-cause mortality.

This single-center retrospective analysis included 278 cirrhotic patients receiving TIPS creation between 2018 and 2022. Pre-TIPS/before-discharge/one-month AMMON-OHE models were constructed by patients' clinical and biochemical variables at different time points, and assessed by integrated Brier scores (IBS), C-index, and decision curves analysis.

Within follow-up (median: 31.8 months), 91 (32.7%) patients developed OHE and 46 (16.5%) died. The AMMON-OHE models outperformed liver function scores in predicting OHE, with one-month model performing best (2-yr: IBS=0.1593, C-index=0.7462). Age, diabetes, albumin, and ammonia were pre-TIPS independent predictors for OHE. Combining age of 65 years further improved the pre-TIPS AMMON-OHE model's predictive performance (2-yr C-index: 0.7124-0.7482) and risk stratification ability, with 2-yr OHE-free incidence further stratified in high-risk patients (from 55.1% to 37.0% and 61.0% [age > and ≤65]; p<0.001) and low-risk patients (from 86.0% to 63.0% and 94.7% [age > and ≤65]; p=0.021).OHE occurrence was associated with reduced survival rate (p<0.001, HR: 4.49, 95% CI: 2.44-8.26), especially early, non-precipitated, severe, or recurrent/persistent OHE (p<0.001 for all). Such risk stratification was applicable to differentiate death risk, whether combining age (p=0.002) or not (p=0.019).

For cirrhotic patients with TIPS, the AMMON-OHE model can be used to identify high OHE risk patients before TIPS. Furthermore, the occurrence of post-TIPS OHE is associated with increased mortality.