Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests

Ehrenbauer, Alena F.; Schneider, Hannah; Stockhoff, Lena; Tiede, Anja; Lorenz, Charlotte; Dirks, Meike; Witt, Jennifer; Gabriel, Maria M.; Wedemeyer, Heiner; Hinrichs, Jan B.; Weißenborn, Karin; Maasoumy, Benjamin

doi:10.1016/j.jhepr.2023.100829

Cited by 6 publications

(3 citation statements)

References 47 publications

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“…However, most existing studies mainly focus on conventional clinical factors, such as serum sodium, ammonia, diameter of stent, and portosystemic pressure gradient, to explore their correlation with the incidence of OHE [ 7 , 9 , 24 – 26 ]. Moreover, some studies have also examined the relationship between minimal hepatic encephalopathy (mHE) and post-TIPS OHE [ 27 , 28 ]. However, the diagnosis of mHE is challenging, as there are no universally accepted diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

Myosteatosis is an independent risk factor for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunting

Shi,

Yin,

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Objective The relationship between skeletal muscle and adipose tissue compositions and risk of overt hepatic encephalopathy (OHE) following transjugular intrahepatic portosystemic shunt (TIPS) treatment needs to be investigated. Methods A total of 282 patients were collected from two medical centres. The median time of follow-up was 48.23 + 1.36 months and the first-year results of all patients after TIPS therapy were collected. The muscle and adipose tissue indices were quantified at the third lumbar vertebra level. Sarcopenia and myosteatosis were defined according to previous researches. Receiver operating characteristic curves, chi-square test, univariate and multivariate logistic regression analyses were employed to investigate the potential association between muscle and adipose indices, sarcopenia, myosteatosis and the risk of developing post-TIPS OHE. Results All skeletal muscle indices, adipose tissue indices and sarcopenia had limited associations with post-TIPS OHE. Myosteatosis (148 cases, 52.5%, 55 with OHE, 37.2%) was identified as an independent risk factor for post-TIPS OHE. with P < 0.001 in Chi-square test, P < 0.001, odds ratio (OR): 2.854, 95% confidence interval (CI): 1.632–4.993 in univariate logistic regression analyses, and P = 0.007, OR: 2.372, 95% CI: 1.268–4.438 in multivariate logistic regression analyses, respectively. Conclusion Our results showed that myosteatosis was proven as an independent risk factor for the development of post-TIPS OHE.

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Section: Discussionmentioning

confidence: 99%

Myosteatosis is an independent risk factor for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunting

Shi,

Yin,

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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“… 33 Testing for minimal HE before TIPS insertion does not guarantee that overt HE will not appear after TIPS. 54 In the end, the decision to place a TIPS is often made on an individual basis. Experts usually advocate that TIPS is contraindicated in patients with a history of recurrent or persistent overt HE or in those with advanced liver dysfunction defined by a Child–Pugh score >13 or a Model for End‐Stage Liver Disease (MELD) score >19.…”

Section: Advances In the Use Of Transjugular Intrahepatic Porto‐syste...mentioning

confidence: 99%

Recent developments in the management of ascites in cirrhosis

Lan,

Chen,

Tang

et al. 2024

UEG Journal

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In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a long time in the management of portal hypertension may have beneficial effects that were not previously identified. Long‐term albumin infusion may improve survival in patients with cirrhosis and ascites while beta‐blockers may reduce ascites occurrence. Transjugular intrahepatic porto‐systemic shunt (TIPS) placement may also improve survival in selected patients in addition to the control with ascites. Low‐flow ascites pump insertion can be another option for some patients with intractable ascites. In this review, we summarize the latest data related to the management of ascites occurring in cirrhosis. There are still unanswered questions, such as the optimal use of albumin as a long‐term therapy, the place of beta‐blockers, and the best timing for TIPS placement to improve the natural history of ascites, as well as the optimal stent diameter to reduce the risk of shunt‐related side‐effects. These issued should be addressed in future studies.

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“…In line with that, Berlioux et al used the Critical Flicker Frequency test (CFF) to identify MHE before and several times after TIPS placement and found that OHE developed more often in patients with MHE diagnosed by CFF despite the absence of prior OHE; and that a normal CFF value equal to or greater than 39 Hz had a 100% negative predictive value for post-TIPS OHE [ 34 ]. A contradictory study using the PSE, CFF, and Animal Naming Test (ANT) found that HE risk increased with the number of abnormal tests while no single test was the most important [ 65 ]. Lastly, a Danish single-centre study where MHE was systematically diagnosed pre-TIPS using continuous reaction times (CRT) test found the overall OHE incidence was 38% during the first year post-TIPS, but when patients with MHE before TIPS were excluded, the incidence only decreased to 33% [ 28 ].…”

Section: Risk Factorsmentioning

confidence: 99%

Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy—A Review of the Past Decade’s Literature Focusing on Incidence, Risk Factors, and Prophylaxis

Friis,

Thomsen,

Laleman

et al. 2023

JCM

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Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension and its’ complications in liver cirrhosis, yet the development of hepatic encephalopathy (HE) remains a significant concern. This review covers the reported incidence, risk factors, and management strategies for post-TIPS HE over the past decade. Incidence varies widely (7–61%), with factors like age, liver function, hyponatremia, and spontaneous portosystemic shunts influencing risk. Procedural aspects, including TIPS timing, indication, and stent characteristics, also contribute. Pharmacological prophylaxis with lactulose and rifaximin shows promise, but current evidence is inconclusive. Procedural preventive measures, such as shunt embolization and monitoring portal pressure gradients, are explored. Treatment involves pharmacological options like lactulose and rifaximin, and procedural interventions like stent diameter reduction. Ongoing studies on novel predictive markers and emerging treatments, such as faecal microbiota transplant, reflect the evolving landscape in post-TIPS HE management. This concise review provides clinicians with insights into the multifaceted nature of post-TIPS HE, aiding in improved risk assessment, prophylaxis, and management for patients undergoing TIPS procedures.

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Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests

Cited by 6 publications

References 47 publications

Myosteatosis is an independent risk factor for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunting

Myosteatosis is an independent risk factor for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunting

Recent developments in the management of ascites in cirrhosis

Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy—A Review of the Past Decade’s Literature Focusing on Incidence, Risk Factors, and Prophylaxis

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