Torkian Pooya, Wallace Stephanie, Lim Nicholas, Flanagan Siobhan, Golzarian Jafar, Young Shamar J
Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, B-228 Mayo Memorial Building, MMC 292420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA.
Cardiovasc Intervent Radiol. 2024 Jan;47(1):69-77. doi: 10.1007/s00270-023-03566-z. Epub 2023 Oct 5.
To evaluate the impact of pre-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) on developing post-TIPS HE.
In this retrospective, single center observational study, all patients who underwent successful TIPS placement between January 2005 and May 2020 with data pertaining to HE in their chart were included. Patient demographics and procedural details were recorded. Clinical outcomes post-TIPS, were collected and compared across patients with and without pre-TIPS HE.
Of 326 included patients, 159 (159/326, 48.8%) had a history of pre-TIPS HE. In total those without a history of HE were more likely to develop HE during follow up (136 (136/167, 81.4%) vs 107 (107/159, 67.3%), p = 0.001). When evaluating for predictors of developing HE within 3 months of TIPS placement, no significant variables were found on logistic regression, including prior history of HE (HR 1.16 (95% CI 0.73-1.84), p = 0.529). Univariate and multivariate regression analysis, however, showed that a history of HE was predictive of developing HE at any point in the follow-up period (p = 0.002 and p = 0.008, respectively). However, on Kaplan-Meier analysis no significant difference in the development of HE (p = 0.574) or hospital admission for HE (p = 0.554) post-TIPS was seen between patients with and without pre-TIPS HE. Additionally, there was no difference in 3-month survival (p = 0.412) or overall survival post-TIPS survival (p = 0.798).
Pre-TIPS HE did not predict the development of HE within 3 months of TIPS. Outcomes such as hospital admission and survivability were not different between patients with and without prior HE.
评估经颈静脉肝内门体分流术（TIPS）前肝性脑病（HE）对TIPS术后发生HE的影响。
在这项回顾性单中心观察性研究中，纳入了2005年1月至2020年5月期间成功进行TIPS置入且病历中有HE相关数据的所有患者。记录患者的人口统计学资料和手术细节。收集TIPS术后的临床结局，并在有和没有TIPS前HE的患者之间进行比较。
在纳入的326例患者中，159例（159/326，48.8%）有TIPS前HE病史。总体而言，无HE病史的患者在随访期间更有可能发生HE（136例（136/167，81.4%）对107例（107/159，67.3%），p = 0.001）。在评估TIPS置入后3个月内发生HE的预测因素时，逻辑回归未发现显著变量，包括HE既往史（HR 1.16（95%CI 0.73 - 1.84），p = 0.529）。然而，单因素和多因素回归分析表明，HE病史可预测随访期间任何时间发生HE（分别为p = 0.002和p = 0.008）。然而，根据Kaplan-Meier分析，有和没有TIPS前HE的患者在TIPS术后发生HE（p = 0.574）或因HE住院（p = 0.554）方面没有显著差异。此外，3个月生存率（p = 0.412）或TIPS术后总生存率（p = 0.798）也没有差异。
TIPS前HE不能预测TIPS术后3个月内HE的发生。有和没有既往HE的患者在住院和生存能力等结局方面没有差异。
