2017, Number 1
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Ann Hepatol 2017; 16 (1)
Observational Cohort Study of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Routhu M, Safka V, Kumar RS, Fejfar T, Jirkovsky V, Krajina A, Cermakova E, Hulek P, Hosak L
Language: English
References: 46
Page: 140-146
PDF size: 205.71 Kb.
ABSTRACT
Introduction and aim. Hepatic encephalopathy (HE) is a common complication of transjugular intrahepatic portosystemic shunting
(TIPS). It is associated with a reduced quality of life and poor prognosis. The aim of this study was to compare two groups of
patients who did and did not develop overt HE after TIPS. We looked for differences between these groups before TIPS.
Material
and methods. A study of 895 patients was conducted based on a retrospective analysis of clinical data. Data was analyzed using
Fisher’s exact test, χ
2, Mann Whitney test, unpaired t-test and logistic regression. After the initial analyses, we have looked at a regression
models for the factors associated with development of HE after TIPS.
Results. 257 (37.9%) patients developed HE after
TIPS. Patients’ age, pre-TIPS portal venous pressure, serum creatinine, aspartate transaminase, albumin, presence of diabetes
mellitus and etiology of portal hypertension were statistically significantly associated with the occurrence of HE after TIPS (p ‹
0.01). However, only the age, pre-TIPS portal venous pressure, serum creatinine, presence of diabetes mellitus and etiology of portal
hypertension contributed to the regression model. Patients age, serum creatinine, presence of diabetes mellitus and portal vein
pressure formed the model describing development of HE after TIPS for a subgroup of patients with refractory ascites.
Conclusion.
We have identified, using a substantial sample, several factors associated with the development of HE after TIPS. This could
be helpful in further research.
REFERENCES
American Association for the Study of Liver Diseases, European Association for the Study of the Liver. Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol 2014; 61: 642-59.
Masson S, Mardini HA, Rose JD, Record CO. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt insertion: a decade of experience. QJM 2008; 101: 493-501.
Zuckerman DA, Darcy MD, Bocchini TP, Hildebolt CF. Encephalopathy after transjugular intrahepatic portosystemic shunting: analysis of incidence and potential risk factors. AJR Am J Roentgenol 1997; 169: 1727-31.
Russo MW, Sood A, Jacobson IM, Brown RS. Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. Am J Gastroenterol 2003; 98: 2521-7.
Campbell MS, Brensinger CM, Sanyal AJ, Gennings C, Wong F, Kowdley KV, Mccashland T, et al. Quality of life in refractory ascites: transjugular intrahepatic portal-systemic shunting versus medical therapy. Hepatology 2005; 42: 635-40.
Stewart CA, Malinchoc M, Kim WR, Kamath PS. Hepatic encephalopathy as a predictor of survival in patients with endstage liver disease. Liver Transpl 2007; 13: 1366-71.
Stefánková J, Hulek P, Babu A, Cermáková E, Safka V, Stefanek J, Fejfar T, et al. Hepatic encephalopathy due to TIPS-retrospective study. Hepatogastroenterology 2007; 54: 480-4.
ter Borg PC, Hollemans M, Van Buuren HR, Vleggaar FP, Groeneweg M, Hop WC, Laméris JS. Transjugular Intrahepatic Portosystemic Shunts: Long-term Patency and Clinical Results in a Patient Cohort Observed for 3–9 Years. Radiology 2004; 231: 537-45.
Riggio O, Merlli M, Pedretti G, Servi R, Meddi P, Lionetti R, Rossi P, et al. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Incidence and risk factors. Dig Dis Sci 1996; 41: 578-84.
Sanyal AJ, Freedman AM, Shiffman ML, Purdum PP, Luketic VA, Cheatham AK. Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: results of a prospective controlled study. Hepatology 1994; 20: 46-55.
Mamiya Y, Kanazawa H, Kimura Y, Narahara Y, Yamate Y, Nakatsuka K, Sakamoto C. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Hepatol Res 2004; 30: 162-8.
Hassoun Z, Deschęnes M, Lafortune M, Dufresne MP, Perreault P, Lepanto L, Gianfelice D, et al. Relationship between pre-TIPS liver perfusion by the portal vein and the incidence of post-TIPS chronic hepatic encephalopathy. Am J Gastroenterol 2001; 96: 1205-9.
Somberg KA, Riegler JL, Laberge JM, Doherty-Simor MM, Bachetti P, Roberts JP, Lake JR. Hepatic encephalopathy after transjugular intrahepatic portosystemic shunts: incidence and risk factors. Am J Gastroenterol 1995; 90: 549-55.
Rössle M, Deibert P, Haag K, Ochs A, Olschewski M, Siegerstetter V, Hauenstein KH, et al. Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding. Lancet 1997; 349: 1043-9.
Bahn E, Nolte W, Kurth C, Ramadori G, Rüther E, Wiltfang J. Quantification of the electroencephalographic theta/alpha ratio for the assessment of portal-systemic encephalopathy following implantation of transjugular intrahepatic portosystemic stent shunt (TIPSS). Metab Brain Dis 2002; 17: 19-28.
François E, García-Pagán JC, Bru C, Feu F, Gilabert R, Escorsell A, Bosch J, et al. [Effects of percutaneous intrahepatic portosystemic shunt on splanchnic and systemic hemodynamics in patients with portal hypertension]. Gastroenterol Hepatol 1997; 20: 1-4.
Deng D, Liao MS, Qin JP, Li XA. Relationship between pre- TIPS hepatic hemodynamics and postoperative incidence of hepatic encephalopathy. Hepatobiliary Pancreat Dis Int 2006; 5: 232-6.
Bai M, Han GH, Yuan SS, Yin ZX, He CY, Wang JH, Qi XS, et al. [Early hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: the risk factors and long-time survival]. Zhonghua Gan Zang Bing Za Zhi 2011; 19: 498-501.
Nägele T, Seeger U, Pereira P, Seitz D, Klose U, Kaiser S, Eisold M, et al. [MR proton spectroscopy to monitor the concentration changes in cerebral metabolites following a TIPS placement]. Rofo 1999; 170: 298-303.
Nolte W, Wiltfang J, Schindler C, Münke H, Unterberg K, Zumhasch U, Figulla HR, et al. Portosystemic hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with cirrhosis: clinical, laboratory, psychometric, and electroencephalographic investigations. Hepatology 1998; 28: 1215-25.
Bureau C, Pagan JC, Layrargues GP, Metivier S, Bellot P, Perreault P, Otal P, et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study. Liver Int 2007; 27: 742-7.
Stefánková J, Fejfar T, Safka V, Hulek P, Krajina A, Fendrichová M. [Hepatic encephalopathy after TIPS-retrospective study]. Vnitr Lek 2002; 48: 390-5.
Angeloni S, Merli M, Salvatori FM, De Santis A, Fanelli F, Pepino D, Attili AF, et al. Polytetrafluoroethylene-covered stent grafts for TIPS procedure: 1-year patency and clinical results. Am J Gastroenterol 2004; 99: 280-5.
Thuluvath PJ, Bal JS, Mitchell S, Lund G, Venbrux A. TIPS for management of refractory ascites: response and survival are both unpredictable. Dig Dis Sci 2003; 48: 542-50.
Amarapurkar DN, Punamiya S, Patel ND. An experience with covered transjugular intrahepatic portosystemic shunt for refractory ascites from western India. Ann Hepatol 2006; 5: 103-8.
Patel NH, Sasadeusz KJ, Seshadri R, Chalasani N, Shah H, Johnson MS, Namyslowski J, et al. Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality. J Vasc Interv Radiol 2001; 12: 1279-84.
Pomier-Layrargues G, Villeneuve JP, Deschęnes M, Bui B, Perreault P, Fenyves D, Willems B, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial. Gut 2001; 48: 390-6.
Ginčs P, Arroyo V. Paracentesis in the management of cirrhotic ascites. J Hepatol 1993; 17(Suppl. 2): 14-8.
D’Amico G, Luca A, Morabito A, Miraglia R, D’Amico M. Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Gastroenterology 2005; 129: 1282-93.
Gordon JD, Colapinto RF, Abecassis M, Makowka L, Langer B, Blendis LM, Taylor B, et al. Transjugular intrahepatic portosystemic shunt: a nonoperative approach to life-threatening variceal bleeding. Can J Surg 1987; 30: 45-9.
Krajina A, Hůlek P, Eliás P, Michl A, Heger L, Volfová M, Niangová I, et al. [Transjugular intrahepatic portosystemic shunt]. Cor Vasa 1993; 35: 157-61.
Zizka J, Eliás P, Krajina A, Michl A, Lojík M, Ryska P, Masková J, et al. Value of Doppler Sonography in Revealing Transjugular Intrahepatic Portosystemic Shunt Malfunction. AJR Am J Roentgenol 2000; 175(1): 141-8.
IBM Corp.: Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.
Hintze J: NCSS 9. NCSS, LLC. Kaysville, Utah, USA. www.NCSS.com.
Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124: 91-6.
Child CG, Turcotte JG. Surgery and portal hypertension. In: Child CG (eds.). The liver and portal hypertension. Philadelphia: Saunders; 1964, p. 50-64.
Kumar A, Sharma P, Sarin SK. Hepatic venous pressure gradient measurement: time to learn! Indian J Gastroenterol 2008; 27: 74-80.
Quero JC, Hartmann IJ, Meulstee J, Hop WC, Schalm SW. The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological tests and automated electroencephalogram analysis. Hepatology 1996; 24: 556-60.
Awad N, Gagnon M, Messier C. The Relationship between Impaired Glucose Tolerance, Type 2 Diabetes, and Cognitive Function. J Clin Exp Neuropsychol 2004; 26: 1044-80.
Friedman S, Schiano T. Cirrhosis and its sequelae. In: Goldman L, Ausiello D (eds.). Cecil Textbook of Medicine. 22nd ed. Philadelphia: Saunders; 2004, p. 936-44.
Crawford JM. Liver and biliary tract. In: Kumar V, Abbas AK, Fausto N (eds.). Robbins and Cotran Pathologic Basis of Disease. 7th ed. Philadelphia: Elsevier Saunders; 2005, p. 877-938.
Stockwell T, Zhao J, Greenfield T, Li J, Livingston M, Meng Y. Estimating under- and over-reporting of drinking in national surveys of alcohol consumption: Identification of consistent biases across four English-speaking countries. Addiction 2016; 7: [Epub ahead of print].
Rinella ME, Loomba R, Caldwell SH, Kowdley K, Charlton M, Tetri B, Harrison SA. Controversies in the Diagnosis and Management of NAFLD and NASH. Gastroenterol Hepatol (N Y) 2014; 10(4): 219-27.
Leite NC, Villela-Nogueira CA, Cardoso CRL, Salles GF. Nonalcoholic fatty liver disease and diabetes: From physiopathological interplay to diagnosis and treatment. World J Gastroenterol 2014; 20(26): 8377-92.
Pomier-Layrargues G, Villeneuve J, Deschenes M, Bui B, Perreault P, Fenyves D, Willems B, et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial. Gut 2001; 48(3): 390-6.
Biecker E, Roth F, Heller J, Schild HH, Sauerbruch T, Schepke M. Prognostic role of the initial portal pressure gradient reduction after TIPS in patients with cirrhosis. Eur J Gastroenterol Hepatol 2007; 19(10): 846-52.