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Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) according to its severity and temporal grading classification

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
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Abstract

Objectives

To evaluate hepatic encephalopathy (HE) incidence after transjugular intrahepatic portosystemic shunt (TIPS) and classify by gravity and frequency.

Methods

This is a retrospective study of 75 patients with no previous episodes of HE who underwent TIPS between 2008 and 2014 with clinical follow-up after 6 and 12 months. Patient risk factors evaluated include age, INR (international normalized ratio), creatinine, bilirubin, and MELD score (Model for End-of-stage Liver Disease). HE was reported using two classifications: (1) gravity divided in moderate (West-Haven grades I–II) and severe (III–IV); (2) frequency divided in episodic and recurrent/persistent.

Results

Overall HE incidence was 36% at 6 months, with 12 month incidence significantly decreased to 27% (p = 0.02). 13/75 (17%) patients had one episode of moderate HE, while 3/75 (4%) patients had severe recurrent/persistent HE. Age was the only pre-TIPS risk predictor. Post-TIPS bilirubin and INR showed variations from basal values only in the presence of diagnosed HE. Bilirubin significantly increased (p = 0.03) in correlation to HE severity, whereas INR changes correlated with temporal frequency (p = 0.04). HE distribution classified for severity is similar at 6 and 12 months, whereas when classified for frequency shows significant differences (p = 0.04).

Conclusions

A classification by gravity and frequency attests post-TIPS HE as a manageable risk. Monitoring of bilirubin and INR may help on clinical management risk stratification.

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Abbreviations

TIPS:

Transjugular intrahepatic portosystemic shunt

HE:

Hepatic encephalopathy

INR:

International normalized ratio

MELD:

Model for end-of-stage liver disease

FU:

Follow-up

ROC:

Receiver-operating characteristic

AUC:

Area under the curve

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Acknowledgements

The scientific guarantor of this publication is Prof. Giovanni Gandini. The authors state that this work has not received any funding. Prof. Laura Bergamasco provided statistical advice for this manuscript.

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Authors and Affiliations

  1. Radiology Unit, Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy

    Paolo Fonio, Andrea Discalzi, Marco Calandri, Andrea Doriguzzi Breatta, Dorico Righi & Giovanni Gandini

  2. Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy

    Laura Bergamasco

  3. Gastro-Hepatology Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy

    Silvia Martini & Antonio Ottobrelli

Authors
  1. Paolo Fonio
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  2. Andrea Discalzi
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Correspondence to Paolo Fonio.

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Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical standards

Institutional Review Board approval was not required because of its retrospective nature. The study was conducted in good clinical practice according to the Helsinki Declaration of 1975 and subsequent modifications.

Informed consent

Written informed consent was obtained from all patients in this study. Methodology: retrospective, observational, and performed at one institution.

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Fonio, P., Discalzi, A., Calandri, M. et al. Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) according to its severity and temporal grading classification. Radiol med 122, 713–721 (2017). https://doi.org/10.1007/s11547-017-0770-6

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