Digestive Diseases and Sciences

, Volume 60, Issue 4, pp 1059–1066 | Cite as

Clearing the Confusion over Hepatic Encephalopathy After TIPS Creation: Incidence, Prognostic Factors, and Clinical Outcomes

  • Leigh C. Casadaban
  • Ahmad Parvinian
  • Jeet Minocha
  • Janesh Lakhoo
  • Christopher W. Grant
  • Charles E. RayJr.
  • M. Grace Knuttinen
  • James T. Bui
  • Ron C. Gaba
Original Article

Abstract

Purpose

To assess the incidence, prognostic factors, and clinical outcomes of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.

Materials and Methods

In this single-institution retrospective study, 191 patients (m:f = 114:77, median age 54 years, median Model for End-Stage Liver Disease or MELD score 14) who underwent TIPS creation between 1999 and 2013 were studied. Medical record review was used to identify demographic characteristics, liver disease, procedure, and outcome data. Post-TIPS HE within 30 days was defined by new mental status changes and was graded according to the West Haven classification system. The influence of data parameters on HE occurrence and 90-day mortality was assessed using binary logistic regression.

Results

TIPS was successfully created with hemodynamic success in 99 % of cases. Median final PSG was 7 mmHg. HE incidence within 30 days was 42 % (81/191; 22 % de novo, 12 % stable, and 8 % worsening). Degrees of HE included grade 1 (46 %), grade 2 (29 %), grade 3 (18 %), and grade 4 (7 %). Medical therapy typically addressed HE, and shunt reduction was necessary in only three cases. MELD score (P = 0.020) and age (P = 0.009) were significantly associated with HE development on multivariate analysis. Occurrence of de novo HE post-TIPS did not associate with 90-day mortality (P = 0.400), in contrast to worsening HE (P < 0.001).

Conclusions

The incidence of post-TIPS HE is non-trivial, but symptoms are typically mild and medically managed. HE rates are higher in older patients and those with worse liver function and should be contemplated when counseling on expected TIPS outcomes and post-procedure course.

Keywords

Hepatic encephalopathy (HE) Transjugular intrahepatic portosystemic shunt (TIPS) Prognostic factors Clinical outcomes 

Notes

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Leigh C. Casadaban
    • 1
  • Ahmad Parvinian
    • 1
  • Jeet Minocha
    • 2
  • Janesh Lakhoo
    • 2
  • Christopher W. Grant
    • 2
  • Charles E. RayJr.
    • 2
  • M. Grace Knuttinen
    • 2
  • James T. Bui
    • 2
  • Ron C. Gaba
    • 2
  1. 1.University of Illinois College of MedicineChicagoUSA
  2. 2.Department of Radiology, Interventional Radiology SectionUniversity of Illinois Hospital and Health Sciences SystemChicagoUSA

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