Episodic overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt does not increase mortality in patients with cirrhosis

作者：Silvia Nardelli, Oliviero Riggio, Fabio Marra, Stefania Gioia, Dario Saltini, Daniele Bellafante, Valentina Adotti, Tomas Guasconi, Lorenzo Ridola, Martina Rosi, Cristian Caporali, Fabrizio Fanelli, Davide Roccarina, Marcello Bianchini, Federica Indulti, Alessandra Spagnoli, Manuela Merli, Francesco Vizzutti, Filippo Schepis · 发表于：Journal of Hepatology · 年份：2023 · DOI：10.1016/j.jhep.2023.11.033 · 被引用次数：55 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Nutrition and Health in Aging

BACKGROUND & AIMS: Overt hepatic encephalopathy (OHE) is a major complication of transjugular intrahepatic portosystemic shunt (TIPS) placement, given its high incidence and possibility of refractoriness to medical treatment. Nevertheless, the impact of post-TIPS OHE on mortality has not been investigated in a large population. METHODS: We designed a multicenter, non-inferiority, observational study to evaluate the mortality rate at 30 months in patients with and without OHE after TIPS. We analyzed a database of 614 patients who underwent TIPS in three Italian centers and estimated the cumulative incidence of OHE and mortality with competitive risk analyses, setting the non-inferiority limit at 0.12. RESULTS: During a median follow-up of 30 months (IQR 12-30), 293 patients developed at least one episode of OHE. Twenty-seven (9.2%) of them experienced recurrent/persistent OHE. Patients with OHE were older (64 [57-71] vs. 59 [50-67] years, p <0.001), had lower albumin (3.1 [2.8-3.5] vs. 3.25 [2.9-3.6] g/dl, p = 0.023), and had a higher prevalence of pre-TIPS OHE (15.4% vs. 9.0%, p = 0.023). Child-Pugh and MELD scores were similar. The 30-month difference in mortality between patients with and without post-TIPS OHE was 0.03 (95% CI -0.042 to 0.102). Multivariable analysis showed that age (subdistribution hazard ratio 1.04, 95% CI 1.02-1.05, p <0.001) and MELD score (subdistribution hazard ratio 1.09, 95% CI 1.05-1.13, p <0.001), but not post-TIPS OHE, were associated with a high...