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. Ray, Grace Knuttinen, James T. Bui, Ron C. Gaba

Research output: Contribution to journalArticle

29 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1059-1066
Number of pages8
JournalDigestive Diseases and Sciences
Volume60
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
Hepatic Encephalopathy
Incidence
End Stage Liver Disease
Mortality
Medical Records
Liver Diseases
Counseling
Multivariate Analysis
Retrospective Studies
Logistic Models
Hemodynamics

Keywords

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

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Clearing the Confusion over Hepatic Encephalopathy After TIPS Creation : Incidence, Prognostic Factors, and Clinical Outcomes. / Casadaban, Leigh C.; Parvinian, Ahmad; Minocha, Jeet; Lakhoo, Janesh; Grant, Christopher W.; Ray, Charles E.; Knuttinen, Grace; Bui, James T.; Gaba, Ron C.

In: Digestive Diseases and Sciences, Vol. 60, No. 4, 01.04.2015, p. 1059-1066.

Research output: Contribution to journalArticle

Casadaban, Leigh C. ; Parvinian, Ahmad ; Minocha, Jeet ; Lakhoo, Janesh ; Grant, Christopher W. ; Ray, Charles E. ; Knuttinen, Grace ; Bui, James T. ; Gaba, Ron C. / Clearing the Confusion over Hepatic Encephalopathy After TIPS Creation : Incidence, Prognostic Factors, and Clinical Outcomes. In: Digestive Diseases and Sciences. 2015 ; Vol. 60, No. 4. pp. 1059-1066.
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T2 - Incidence, Prognostic Factors, and Clinical Outcomes

AU - Casadaban, Leigh C.

AU - Parvinian, Ahmad

AU - Minocha, Jeet

AU - Lakhoo, Janesh

AU - Grant, Christopher W.

AU - Ray, Charles E.

AU - Knuttinen, Grace

AU - Bui, James T.

AU - Gaba, Ron C.

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N2 - 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.

AB - 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.

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KW - Prognostic factors

KW - Transjugular intrahepatic portosystemic shunt (TIPS)

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