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Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury
BACKGROUND: Hepatic encephalopathy, which is a serious complication, and sarcopenia are undesirable consequences in cirrhosis. Transjugular intrahepatic portosystemic shunt increases the risk of hepatic encephalopathy. We investigated the effect of sarcopenia on the incidence of post-transjugular in...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Turkish Society of Gastroenterology
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210830/ https://www.ncbi.nlm.nih.gov/pubmed/36620928 http://dx.doi.org/10.5152/tjg.2023.21964 |
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author | Bhatia Kapoor, Puja Benjamin, Jaya Tripathi, Harshita Patidar, Yashwant Maiwall, Rakhi Kumar, Guresh Joshi, Yogendra Kumar Kumar Sarin, Shiv |
author_facet | Bhatia Kapoor, Puja Benjamin, Jaya Tripathi, Harshita Patidar, Yashwant Maiwall, Rakhi Kumar, Guresh Joshi, Yogendra Kumar Kumar Sarin, Shiv |
author_sort | Bhatia Kapoor, Puja |
collection | PubMed |
description | BACKGROUND: Hepatic encephalopathy, which is a serious complication, and sarcopenia are undesirable consequences in cirrhosis. Transjugular intrahepatic portosystemic shunt increases the risk of hepatic encephalopathy. We investigated the effect of sarcopenia on the incidence of post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy. METHODS: Clinical data of patients who underwent transjugular intrahepatic portosystemic shunt were extracted retrospectively. Computed tomography images at L3 level of scans performed prior to transjugular intrahepatic portosystemic shunt were analyzed to assess skeletal muscle index—expressed as skeletal muscle area (cm(2))/ height (m(2)). RESULTS: Of 210 patients who underwent transjugular intrahepatic portosystemic shunt, complete information was available in 79 [male: 68 (86%); age: 50.5 ± 11.2 years; Child–Turcotte–Pugh score: 8.81 ± 1.23; etiology—alcohol: 44 (56%), non-alcoholic steatohepatitis: 16 (20%), others: 19 (24%); transjugular intrahepatic portosystemic shunt indication—ascites: 56 (71%); bleed: 23 (29%); sarcopenics: 42 (53%)]. Post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy developed in 29 (37%) patients. In patients who developed hepatic encephalopathy, both serum ammonia [177.6 ± 82.5 vs. 115.5 ± 40.5 µg/dL, P = .008] and prevalence of sarcopenia [69% vs. 44%; P = .02; odds ratio (95% CI): 2.8 (1.08-7.4), P = .02] were higher, with sarcopenics having 3 times higher risk of hepatic encephalopathy and 8 times higher risk of multiple episode of hepatic encephalopathy [31% vs. 5.4%; odds ratio (95% CI): 8.2 (1.68-40.5), P = .009]. In multivariate analysis, age [odds ratio (95% CI): 1.05 (1.001-1.11), P = .047], serum albumin [odds ratio (95% CI): 0.162 (0.05-0.56), P = .004], and skeletal muscle index [odds ratio (95% CI): 0.925 (0.89-0.99), P = .017] were independently associated with post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy. CONCLUSIONS: Sarcopenia is present in nearly half of the cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt, which increases the risk of a single episode of hepatic encephalopathy by 3-fold and that of multiple episodes of hepatic encephalopathy by 8-fold after transjugular intrahepatic portosystemic shunt procedure. Increased skeletal muscle index is associated with decreased risk of hepatic encephalopathy. |
format | Online Article Text |
id | pubmed-10210830 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Turkish Society of Gastroenterology |
record_format | MEDLINE/PubMed |
spelling | pubmed-102108302023-05-26 Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury Bhatia Kapoor, Puja Benjamin, Jaya Tripathi, Harshita Patidar, Yashwant Maiwall, Rakhi Kumar, Guresh Joshi, Yogendra Kumar Kumar Sarin, Shiv Turk J Gastroenterol Original Article BACKGROUND: Hepatic encephalopathy, which is a serious complication, and sarcopenia are undesirable consequences in cirrhosis. Transjugular intrahepatic portosystemic shunt increases the risk of hepatic encephalopathy. We investigated the effect of sarcopenia on the incidence of post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy. METHODS: Clinical data of patients who underwent transjugular intrahepatic portosystemic shunt were extracted retrospectively. Computed tomography images at L3 level of scans performed prior to transjugular intrahepatic portosystemic shunt were analyzed to assess skeletal muscle index—expressed as skeletal muscle area (cm(2))/ height (m(2)). RESULTS: Of 210 patients who underwent transjugular intrahepatic portosystemic shunt, complete information was available in 79 [male: 68 (86%); age: 50.5 ± 11.2 years; Child–Turcotte–Pugh score: 8.81 ± 1.23; etiology—alcohol: 44 (56%), non-alcoholic steatohepatitis: 16 (20%), others: 19 (24%); transjugular intrahepatic portosystemic shunt indication—ascites: 56 (71%); bleed: 23 (29%); sarcopenics: 42 (53%)]. Post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy developed in 29 (37%) patients. In patients who developed hepatic encephalopathy, both serum ammonia [177.6 ± 82.5 vs. 115.5 ± 40.5 µg/dL, P = .008] and prevalence of sarcopenia [69% vs. 44%; P = .02; odds ratio (95% CI): 2.8 (1.08-7.4), P = .02] were higher, with sarcopenics having 3 times higher risk of hepatic encephalopathy and 8 times higher risk of multiple episode of hepatic encephalopathy [31% vs. 5.4%; odds ratio (95% CI): 8.2 (1.68-40.5), P = .009]. In multivariate analysis, age [odds ratio (95% CI): 1.05 (1.001-1.11), P = .047], serum albumin [odds ratio (95% CI): 0.162 (0.05-0.56), P = .004], and skeletal muscle index [odds ratio (95% CI): 0.925 (0.89-0.99), P = .017] were independently associated with post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy. CONCLUSIONS: Sarcopenia is present in nearly half of the cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt, which increases the risk of a single episode of hepatic encephalopathy by 3-fold and that of multiple episodes of hepatic encephalopathy by 8-fold after transjugular intrahepatic portosystemic shunt procedure. Increased skeletal muscle index is associated with decreased risk of hepatic encephalopathy. Turkish Society of Gastroenterology 2023-04-01 /pmc/articles/PMC10210830/ /pubmed/36620928 http://dx.doi.org/10.5152/tjg.2023.21964 Text en 2023 authors https://creativecommons.org/licenses/by/4.0/ Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | Original Article Bhatia Kapoor, Puja Benjamin, Jaya Tripathi, Harshita Patidar, Yashwant Maiwall, Rakhi Kumar, Guresh Joshi, Yogendra Kumar Kumar Sarin, Shiv Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury |
title | Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury |
title_full | Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury |
title_fullStr | Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury |
title_full_unstemmed | Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury |
title_short | Post-transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy: Sarcopenia Adds Insult to Injury |
title_sort | post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy: sarcopenia adds insult to injury |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210830/ https://www.ncbi.nlm.nih.gov/pubmed/36620928 http://dx.doi.org/10.5152/tjg.2023.21964 |
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