Zuo Luo, Lv Yong, Wang Qiuhe, Yin Zhanxin, Wang Zhengyu, He Chuangye, Guo Wengang, Niu Jing, Bai Wei, Li Kai, Yu Tianlei, Yuan Xulong, Chen Hui, Liu Haibo, Xia Dongdong, Wang Enxin, Luo Bohai, Li Xiaomei, Yuan Jie, Han Na, Nie Yongzhan, Fan Daiming, Han Guohong
Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 15 West Changle Road, Xi'an 710032, China; State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Disease and Xijing Hospital of Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 15 West Changle Road, Xi'an 710032, China.
Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 15 West Changle Road, Xi'an 710032, China.
J Vasc Interv Radiol. 2019 Feb;30(2):148-153.e2. doi: 10.1016/j.jvir.2018.08.023. Epub 2019 Jan 9.
To investigate the role of early overt hepatic encephalopathy (OHE) as a clinical marker of prognosis in cirrhosis with a transjugular intrahepatic portosystemic shunt (TIPS) and to assess the relationship between recurrence of OHE and survival after TIPS.
From January 2012 to December 2013, a retrospective study of consecutive patients with cirrhosis and a TIPS was performed at a single institution. A total of 304 patients (196 males; mean age, 52 years) were enrolled during the study period. The mean Model for End-Stage Liver Disease (MELD) score was 11.6. Time-dependent Cox regression was applied to estimate the predictive ability of early OHE (within 3 months after TIPS) and the effect of its frequency on survival.
During a median follow-up of 28.3 months, 115 patients experienced OHE after the TIPS procedure; of these, 54 had at least 2 OHE episodes. Long-term survival worsened in patients with early OHE (hazard ratio [HR] = 2.75; 95% confidence interval [CI]: 1.75-4.32; P < .001). When early OHE was further divided into early-recurrent and single OHE, death was more common in patients with early-recurrent OHE (P < .001) than in patients with early-single OHE (P = .24). After adjustment by MELD score, ascites, serum albumin, indication for TIPS, and age, patients with early-recurrent OHE had a lower probability of survival (HR = 2.91; 95% CI: 1.04-4.89; P < .001). Furthermore, landmark and propensity score analyses confirmed the predictive value of early-recurrent OHE.
Early recurrence of OHE was associated with an increased risk of mortality for patients with cirrhosis who underwent TIPS.
探讨早期显性肝性脑病（OHE）作为经颈静脉肝内门体分流术（TIPS）治疗肝硬化患者预后临床标志物的作用，并评估OHE复发与TIPS术后生存之间的关系。
2012年1月至2013年12月，在一家机构对连续的肝硬化并接受TIPS治疗的患者进行回顾性研究。研究期间共纳入304例患者（196例男性；平均年龄52岁）。终末期肝病模型（MELD）评分均值为11.6。采用时间依赖性Cox回归分析来评估早期OHE（TIPS术后3个月内）的预测能力及其发作频率对生存的影响。
在中位随访28.3个月期间，115例患者在TIPS术后发生OHE；其中54例至少有2次OHE发作。早期发生OHE的患者长期生存率较差（风险比[HR]=2.75；95%置信区间[CI]：1.75 - 4.32；P<.001）。当将早期OHE进一步分为早期复发性和单次OHE时，早期复发性OHE患者的死亡比早期单次OHE患者更常见（P<.001），而早期单次OHE患者死亡情况相对不那么常见（P = 0.24）。在根据MELD评分、腹水、血清白蛋白、TIPS指征和年龄进行调整后，早期复发性OHE患者的生存概率较低（HR = 2.91；95% CI：1.04 - 4.89；P<.001）。此外，地标分析和倾向评分分析证实了早期复发性OHE的预测价值。
OHE早期复发与接受TIPS治疗的肝硬化患者死亡风险增加相关。
