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• W2321841017 abstract "PurposeTo assess the incidence, prognostic factors, and clinical outcomes of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.Materials and MethodsIn this single institution retrospective study, 254 consecutive patients (M:F=159:96, mean age 54 years, mean Model for End Stage Liver Disease or MELD score 16.5) who underwent TIPS creation between 1999-2013 were studied. Medical record review was used to identify demographic (age, gender), liver disease (etiology, Child-Pugh score, MELD score), procedure (stent type, portosystemic pressure gradient or PSG measurements), and outcome data (HE development, 90-day mortality). Post-TIPS HE was defined by new mental status changes (confusion) or alterations in level of consciousness, and was graded according to the West Haven classification system. The influence of data parameters on occurrence of HE was assessed using binary logistic regression.ResultsTIPS were successfully created using covered (n=195) or bare metal (n=60) stents. Hemodynamic success was achieved in 97% cases. Mean final PSG was 7 mm Hg. Incidence of HE within 30-days of TIPS was 34% (86/255). Degrees of HE included grade 0 (n=10, 11.5%), grade 1 (n=43, 50%), grade 2 (n=11, 13%), grade 3 (n=12, 14%), and grade 4 (n=10, 11.5%). Medical therapy generally addressed HE successfully; shunt reduction was necessary in only 2 cases. Patient age (P=0.029) was significantly associated with HE development on univariate and multivariate analysis. Mean age of patients with and without HE were 56 versus 53 years. When 56 years was used as a threshold, incidence of HE was 42% versus 29% in older and younger patients (P = 0.026), respectively. Occurrence of HE did not increase short-term (90-day) mortality (19/86 or 22% versus 41/169 or 24%, P=0.700).ConclusionThe incidence of HE post-TIPS is non-trivial, but symptoms are typically mild and occurrence does not adversely affect short-term patient survival. HE rates are higher in older patients, and age should be contemplated when counseling patients on expected TIPS outcomes and post-procedure course. PurposeTo assess the incidence, prognostic factors, and clinical outcomes of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. To assess the incidence, prognostic factors, and clinical outcomes of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and MethodsIn this single institution retrospective study, 254 consecutive patients (M:F=159:96, mean age 54 years, mean Model for End Stage Liver Disease or MELD score 16.5) who underwent TIPS creation between 1999-2013 were studied. Medical record review was used to identify demographic (age, gender), liver disease (etiology, Child-Pugh score, MELD score), procedure (stent type, portosystemic pressure gradient or PSG measurements), and outcome data (HE development, 90-day mortality). Post-TIPS HE was defined by new mental status changes (confusion) or alterations in level of consciousness, and was graded according to the West Haven classification system. The influence of data parameters on occurrence of HE was assessed using binary logistic regression. In this single institution retrospective study, 254 consecutive patients (M:F=159:96, mean age 54 years, mean Model for End Stage Liver Disease or MELD score 16.5) who underwent TIPS creation between 1999-2013 were studied. Medical record review was used to identify demographic (age, gender), liver disease (etiology, Child-Pugh score, MELD score), procedure (stent type, portosystemic pressure gradient or PSG measurements), and outcome data (HE development, 90-day mortality). Post-TIPS HE was defined by new mental status changes (confusion) or alterations in level of consciousness, and was graded according to the West Haven classification system. The influence of data parameters on occurrence of HE was assessed using binary logistic regression. ResultsTIPS were successfully created using covered (n=195) or bare metal (n=60) stents. Hemodynamic success was achieved in 97% cases. Mean final PSG was 7 mm Hg. Incidence of HE within 30-days of TIPS was 34% (86/255). Degrees of HE included grade 0 (n=10, 11.5%), grade 1 (n=43, 50%), grade 2 (n=11, 13%), grade 3 (n=12, 14%), and grade 4 (n=10, 11.5%). Medical therapy generally addressed HE successfully; shunt reduction was necessary in only 2 cases. Patient age (P=0.029) was significantly associated with HE development on univariate and multivariate analysis. Mean age of patients with and without HE were 56 versus 53 years. When 56 years was used as a threshold, incidence of HE was 42% versus 29% in older and younger patients (P = 0.026), respectively. Occurrence of HE did not increase short-term (90-day) mortality (19/86 or 22% versus 41/169 or 24%, P=0.700). TIPS were successfully created using covered (n=195) or bare metal (n=60) stents. Hemodynamic success was achieved in 97% cases. Mean final PSG was 7 mm Hg. Incidence of HE within 30-days of TIPS was 34% (86/255). Degrees of HE included grade 0 (n=10, 11.5%), grade 1 (n=43, 50%), grade 2 (n=11, 13%), grade 3 (n=12, 14%), and grade 4 (n=10, 11.5%). Medical therapy generally addressed HE successfully; shunt reduction was necessary in only 2 cases. Patient age (P=0.029) was significantly associated with HE development on univariate and multivariate analysis. Mean age of patients with and without HE were 56 versus 53 years. When 56 years was used as a threshold, incidence of HE was 42% versus 29% in older and younger patients (P = 0.026), respectively. Occurrence of HE did not increase short-term (90-day) mortality (19/86 or 22% versus 41/169 or 24%, P=0.700). ConclusionThe incidence of HE post-TIPS is non-trivial, but symptoms are typically mild and occurrence does not adversely affect short-term patient survival. HE rates are higher in older patients, and age should be contemplated when counseling patients on expected TIPS outcomes and post-procedure course. The incidence of HE post-TIPS is non-trivial, but symptoms are typically mild and occurrence does not adversely affect short-term patient survival. HE rates are higher in older patients, and age should be contemplated when counseling patients on expected TIPS outcomes and post-procedure course." @default.
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• W2321841017 date "2014-03-01" @default.
• W2321841017 modified "2023-09-25" @default.
• W2321841017 title "Clearing the confusion on hepatic encephalopathy after TIPS creation: incidence, prognostic factors, and clinical outcomes" @default.
• W2321841017 doi "https://doi.org/10.1016/j.jvir.2013.12.330" @default.
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