Schindler Philipp, Seifert Leon, Masthoff Max, Riegel Arne, Köhler Michael, Wilms Christian, Schmidt Hartmut H, Heinzow Hauke, Wildgruber Moritz
Institute of Clinical Radiology, University Hospital Muenster, D-48149 Muenster, Germany.
Department of Gastroenterology and Hepatology, University Hospital Muenster, D-48149 Muenster, Germany.
J Clin Med. 2020 Feb 19;9(2):567. doi: 10.3390/jcm9020567.
To evaluate predictive parameters for the development of Hepatic Encephalopathy (HE) after Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement and for success of shunt modification in the management of shunt-induced HE.
A retrospective analysis of all patients with TIPS ( = 344) has been performed since 2011 in our university liver center. = 45 patients with HE after TIPS were compared to = 48 patients without HE after TIPS (case-control-matching). Of = 45 patients with TIPS-induced HE, = 20 patients received a reduction stent ( = 18) or TIPS occlusion ( = 2) and were differentiated into responders (improvement by at least one HE grade according to the West Haven classification) and non-responders (no improvement).
Older patient age, increased serum creatinine and elevated International Normalized Ratio (INR) immediately after TIPS placement were independent predictors for the development of HE. In 11/20 patients (responders, 55%) undergoing shunt modification, the HE grade was improved compared with nine non-responders (45%), with no relevant recurrence of refractory ascites or variceal bleeding. A high HE grade after TIPS insertion was the only positive predictor of treatment response ( = 0.019). A total of 10/11 responders (91%) survived the 6 months follow-up after modification but only 6/9 non-responders (67%) survived.
Older patient age as well as an increased serum creatinine and INR after TIPS are potential predictors for the development of HE. TIPS reduction for the treatment of TIPS-induced HE is safe, with particular benefit for patients with pronounced HE.
评估经颈静脉肝内门体分流术（TIPS）置入后肝性脑病（HE）发生的预测参数以及分流术改良治疗分流性HE的成功率。
自2011年以来，我们大学肝脏中心对所有接受TIPS治疗的患者（n = 344）进行了回顾性分析。将45例TIPS术后发生HE的患者与48例TIPS术后未发生HE的患者进行比较（病例对照匹配）。在45例TIPS诱发的HE患者中，20例患者接受了缩窄支架置入（n = 18）或TIPS闭塞（n = 2），并分为反应者（根据西黑文分类法，HE分级至少改善一级）和无反应者（无改善）。
TIPS置入后患者年龄较大、血清肌酐升高和国际标准化比值（INR）升高是HE发生的独立预测因素。在接受分流术改良的20例患者中，11例（反应者，55%）HE分级得到改善，而9例无反应者（45%）则无改善，且难治性腹水或静脉曲张出血无相关复发。TIPS置入后HE分级较高是治疗反应的唯一阳性预测因素（P = 0.019）。共有10/11例反应者（91%）在改良后的6个月随访中存活，但只有6/9例无反应者（67%）存活。
患者年龄较大以及TIPS术后血清肌酐和INR升高是HE发生的潜在预测因素。TIPS缩窄术治疗TIPS诱发的HE是安全的，对HE明显的患者尤其有益。
