No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Abstract

Hepatic encephalopathy (HE) is a major problem in patients submitted to TIPS. Previous studies identified low albumin as a factor associated to post-TIPS HE. In cirrhotics with diuretic-induced HE and hypovolemia, albumin infusion reduced plasma ammonia and improved HE. Our aim was to evaluate if the incidence of overt HE (grade II or more according to WH) and the modifications of venous blood ammonia and psychometric tests during the first month after TIPS can be prevented by albumin infusion. Twenty-three patients consecutively submitted to TIPS were enrolled and treated with 1 g/Kg BW of albumin for the first 2 days after TIPS followed by 0,5 g/Kg BW at day 4th and 7th and then once a week for 3 weeks. Forty-five patients included in a previous RCT (Riggio et al. 2010) followed with the same protocol and submitted to no pharmacological treatment for the prevention of HE, were used as historical controls. No differences in the incidence of overt HE were observed between the group of patients treated with albumin and historical controls during the first month (34 vs 31 %) or during the follow-up (39 vs 48 %). Two patients in the albumin group and three in historical controls needed the reduction of the stent diameter for persistent HE. Venous blood ammonia levels and psychometric tests were also similarly modified in the two groups. Survival was also similar. Albumin infusion has not a role in the prevention of post-TIPS HE.

The Direct Contribution of Astrocytes and Microglia to the Pathogenesis of Hepatic Encephalopathy

“…15 The highest elevations of serum ammonia following liver dysfunction are observed in Type A and Type B HE. 16,17 Arterial and venous ammonia have been reported to be elevated during Type C HE compared to controls, though the values observed are lower than the other types of HE, including in patients with acuteon-chronic liver failure. 16 Besides ammonia, acute liver injury or chronic liver disease is associated with inflammation that contributes to this syndrome, with neuroinflammation being a pathological contributor to overt HE during both acute liver failure and chronic liver disease.…”

Cognitive Impairment Predicts The Occurrence Of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt

“…Further factors were high creatinine levels ( 13 ) and low serum sodium concentration ( 21 ). Despite the exclusion of patients with previous HE and advanced liver disease, the incidence of post-TIPS HE still remains fairly high ( 22 ); thus, other factors are involved.…”

Combined diffusion tensor imaging and magnetic resonance spectroscopy to predict neurological outcome before transjugular intrahepatic portosystemic shunt

“…Rifaximin is currently not recommended as a prophylaxis before TIPSS, and a randomised controlled trial is still recruiting in France to evaluate its efficacy when given 15 days before TIPSS and during 6 months after TIPSS. Although, prophylaxis of HE is not currently recommended after TIPSS . We could imagine that FA evaluation could be performed in routine in accurately selected patients according to biological data previously described to identify patients at higher risk to develop HE after TIPSS.…”