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Predictors of Occurrence and Risk of Hepatic Encephalopathy After TIPS Creation: A 15-Year Experience

  • Clinical Investigation
  • TIPS
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To identify clinical variables, including use of newer Viatorr TIPS endoprosthesis with controlled expansion (VCX) that may affect the occurrence and risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) creation.

Methods

A total of 376 patients who underwent TIPS creation at our institution between 2003 and 2018 were retrospectively identified. Of these patients, 71 received a Viatorr controlled expansion endoprosthesis and 305 received a Viatorr TIPS endoprosthesis (older version without controlled expansion). Multivariate regression analysis was used to identify factors predicting the occurrence of hepatic encephalopathy after TIPS creation; a Cox proportional hazard model was used to assess risk of HE through time to HE onset

Results

A total of 194 patients (52%) developed hepatic encephalopathy after TIPS creation, including 28 of 71 patients (39%) who received a VCX endoprosthesis. Older patient age and the use of Viatorr endoprosthesis without controlled expansion were significantly associated with the development of hepatic encephalopathy overall. Pre-TIPS pressure variables, patient age, plasma international normalized ratio, and model for end-stage liver disease score were risk factors for time to hepatic encephalopathy.

Conclusion

Several variables are mild predictors of early hepatic encephalopathy development after TIPS creation, and the use of VCX endoprosthesis in TIPS creation is associated with a modest lower risk of hepatic encephalopathy. These preliminary findings should be considered in regard to patient selection, endoprosthesis selection, and post-transjugular intrahepatic portosystemic shunt creation monitoring for the development of hepatic encephalopathy.

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Abbreviations

CI:

Confidence interval

HE:

Hepatic encephalopathy

HR:

Hazard ratio

INR:

International normalized ratio

MELD:

Model for end-stage liver disease

OR:

Odds ratio

PSG:

Portosystemic gradient

TIPS:

Transjugular intrahepatic portosystemic shunt

VCX:

Viatorr controlled expansion endoprosthesis

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Acknowledgements

Megan Griffiths, ELS

Funding

This study was not supported by funding.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Wendy Melissa Coronado

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Connie Ju

  3. Cleveland Clinic, Cleveland, OH, USA

    Jennifer Bullen & Baljendra Kapoor

Authors
  1. Wendy Melissa Coronado
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  2. Connie Ju
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  3. Jennifer Bullen
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Correspondence to Wendy Melissa Coronado.

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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 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors. For this type of study, consent for publication is not required.

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Coronado, W.M., Ju, C., Bullen, J. et al. Predictors of Occurrence and Risk of Hepatic Encephalopathy After TIPS Creation: A 15-Year Experience. Cardiovasc Intervent Radiol 43, 1156–1164 (2020). https://doi.org/10.1007/s00270-020-02512-7

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  • DOI: https://doi.org/10.1007/s00270-020-02512-7

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