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The combination of Child–Pugh score and quantitative CT-based spleen volume could predict the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Hepatic encephalopathy (HE) is a common complication in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). The objective of this study was to assess the prognostic factors and make risk stratification of post-TIPS HE.

Methods

This was a retrospective cohort study consisting of cirrhotic patients who had undergone TIPS creation at our center from November 2015 to August 2020. The baseline characteristics including spleen volume (SVol) and other markers were collected. The univariate and multivariate Cox regression analyses were used to identify independent predictors of post-TIPS overt HE (OHE).

Results

Higher Child–Pugh (CP) score (HR 1.334, 95% CI 1.090–1.632, P = 0.005) and smaller SVol (HR 0.999, 95% CI 0.997–1.000, P = 0.004) were identified as the independent risk factors for post-TIPS OHE. And a time-dependent ROC analysis was used to determine the cutoff values of CP score and SVol, which were respectively 6.5 and 773 cm3. Subsequently, the CP-SVol grading system was developed to divide patients into three risk grades according to the above two cutoff values. Kaplan–Meier analysis showed that the cumulative rates of patients free of OHE in Grade 1, 2 and 3 were respectively 96.4% ± 3.5%, 82.1 ± 4.7%, and 59.3% ± 6.4%, which were in descending order (Log rank P < 0.001).

Conclusion

SVol might be a novel marker to predict the prognosis of post-TIPS OHE, and the proposed CP-SVol grading system composed of CP score and SVol achieved a superior predictive performance.

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Data availability

Please contact the corresponding author for data request.

Abbreviations

HE:

Hepatic encephalopathy

TIPS:

Transjugular intrahepatic portosystemic shunt

SVol:

Spleen volume

OHE:

Overt hepatic encephalopathy

CT:

Computed tomography

CP:

Child–Pugh

MELD:

Model for end-stage liver disease

PVT:

Portal vein thrombosis

SPSS:

Spontaneous portosystemic shunt

PPG:

Portal pressure gradient

PACS:

Picture archiving and communication systems

ROI:

Regions of interest

SD:

Standard deviation

OR:

Odds ratio

CI:

Confidence interval

ROC:

Receiver operating characteristic

AUC:

Area under the curve

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Acknowledgements

This study was funded by Grant from National Nature Science Foundation of China (Grant no. 81873917).

Funding

This study was funded by Grant from National Nature Science Foundation of China (Grant No. 81873917).

Author information

Author notes

  1. Jiacheng Liu and Chen Zhou contributed equally.

Authors and Affiliations

  1. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China

    Jiacheng Liu, Chen Zhou, Yingliang Wang, Chongtu Yang, Qin Shi, Songjiang Huang, Yang Chen, Tongqiang Li & Bin Xiong

  2. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China

    Jiacheng Liu, Chen Zhou, Yingliang Wang, Chongtu Yang, Qin Shi, Songjiang Huang, Yang Chen, Tongqiang Li & Bin Xiong

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  1. Jiacheng Liu
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Contributions

Study conception and design: BX and JL; acquisition of data: JL, CZ, YW, QS and CY; analysis and interpretation of data: JL, CZ, SH, YC and TL; drafting of manuscript: JL and CZ; and critical revision: BX.

Corresponding author

Correspondence to Bin Xiong.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective study was approved by the institutional review board of the Union Hospital, Tongji Medical college, Huazhong University of Science and Technology.

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As a retrospective analysis, informed consent in this study was waived.

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Liu, J., Zhou, C., Wang, Y. et al. The combination of Child–Pugh score and quantitative CT-based spleen volume could predict the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation. Abdom Radiol 46, 3464–3470 (2021). https://doi.org/10.1007/s00261-021-02972-6

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  • DOI: https://doi.org/10.1007/s00261-021-02972-6

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