Early Occurrence of Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt Insertion is Linked to Impaired Survival: A Multicenter Cohort Study

作者：Martin Kabelitz, Lisa Sandmann, Michael Praktiknjo, Jim Benjamin Mauz, Timo Alexander Auer, Tony Bruns, Johannes Chang, Cornelius Engelmann, Uli Fehrenbach, Jan B. Hinrichs, Christian Jansen, Roman Kloeckner, Johannes Kluwe, Michael Köhler, Carsten Meyer, Felix Piecha, Maike R. Pollmanns, Cristina Ripoll, Michael Schultheiß, Leon Louis Seifert, F Stöhr, Lukas Sturm, Jonel Trebicka, Alexander Zipprich, Christian Labenz, Dominik Bettinger, Benjamin Maasoumy, Marlene Reincke, Hannah Rieland, Charlotte Rohrer, Robert Thimme, Anja Tiede, Lena Stockhoff, Bernhard C. Meyer, Markus Kimmann, Juliana Gödiker, Frank Erhard Uschner · 发表于：Clinical Gastroenterology and Hepatology · 年份：2025 · DOI：10.1016/j.cgh.2025.01.024 · 被引用次数：11 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND & AIMS: Hepatic encephalopathy (HE) is a common complication following transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, the prognostic significance of overt HE post-TIPS remains controversial. METHODS: We screened 2137 patients who underwent TIPS insertion at 8 German tertiary care centers between 2004 and 2021. Patients with pre-emptive TIPS placement, hepatocellular carcinoma, missing data, and non-PTFE covered stents were excluded. Competing risk analysis was performed, considering liver transplantation as a competing event. To correct for immortal time bias, landmark analyses were conducted, with the landmark being set at 30 and 90 days post-TIPS. Outcome data were assessed for up to 30 months post-TIPS insertion. RESULTS: A total of 1356 patients (median Model for End-stage Liver Disease [MELD], 13 [interquartile range (IQR), 10-17]; age, 60 years [IQR, 54-67 years]; 64% male; 12% HE before TIPS), were included. Overall, HE post-TIPS was linked to impaired survival (P < .001; subdistribution hazard ratio [sHR], 1.41; 95% confidence interval [CI],1.15-1.73). However, this was only confirmed if HE occurred within the first 30 days post-TIPS (early HE; P < .001; sHR, 2.02; 95% CI, 1.59-2.57). Additionally, patients with a history of HE (P < .001; sHR, 1.59; 95% CI, 1.21-2.07) and history of HE and early HE post-TIPS (P < .001; sHR, 3.44; 95% CI, 2.34-5.04) showed impaired survival. These findings were confirmed in the landmark and multivar...