Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests

BACKGROUND & AIMS: Hepatic encephalopathy (HE) is a frequent and severe complication in patients after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for post-TIPS HE remain poorly defined. Minimal HE (mHE) is a well-known risk factor for overt HE in patien...

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Autores principales: Ehrenbauer, Alena F., Schneider, Hannah, Stockhoff, Lena, Tiede, Anja, Lorenz, Charlotte, Dirks, Meike, Witt, Jennifer, Gabriel, Maria M., Wedemeyer, Heiner, Hinrichs, Jan B., Weissenborn, Karin, Maasoumy, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10432804/
https://www.ncbi.nlm.nih.gov/pubmed/37600959
http://dx.doi.org/10.1016/j.jhepr.2023.100829
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author Ehrenbauer, Alena F.
Schneider, Hannah
Stockhoff, Lena
Tiede, Anja
Lorenz, Charlotte
Dirks, Meike
Witt, Jennifer
Gabriel, Maria M.
Wedemeyer, Heiner
Hinrichs, Jan B.
Weissenborn, Karin
Maasoumy, Benjamin
author_facet Ehrenbauer, Alena F.
Schneider, Hannah
Stockhoff, Lena
Tiede, Anja
Lorenz, Charlotte
Dirks, Meike
Witt, Jennifer
Gabriel, Maria M.
Wedemeyer, Heiner
Hinrichs, Jan B.
Weissenborn, Karin
Maasoumy, Benjamin
author_sort Ehrenbauer, Alena F.
collection PubMed
description BACKGROUND & AIMS: Hepatic encephalopathy (HE) is a frequent and severe complication in patients after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for post-TIPS HE remain poorly defined. Minimal HE (mHE) is a well-known risk factor for overt HE in patients with cirrhosis without TIPS. We aimed to evaluate three tools frequently used for diagnosing mHE for their dynamic changes and their predictive value for overt HE after TIPS. METHODS: We prospectively recruited 84 consecutive patients before TIPS insertion and monitored them for 180 days for post-TIPS HE. Before TIPS insertion, the patients underwent the portosystemic encephalopathy (PSE) syndrome test, the animal naming test (ANT), and the critical flicker frequency (CFF). Patients were retested after TIPS insertion. RESULTS: The majority of patients were male (67.9%), and the predominant indication for TIPS was refractory ascites (75%). Median age was 59 years, model for end-stage liver disease score was 12, and 66.3%, 64.6%, and 28.4% patients had evidence for mHE according to the PSE syndrome test, ANT, and CFF, respectively. Overall, 25 patients developed post-TIPS HE within 180 days after TIPS insertion. Post-TIPS incidence of overt HE was 22.2, 28.6, 45.5, and 55.6% in those with no, one, two, and three pathological tests at baseline, respectively. However, none of the three tests was significantly associated with post-TIPS HE. Of note, mean performance in all tests remained stable over time after TIPS insertion. CONCLUSIONS: PSE syndrome test, ANT and CFF, which are frequently used for diagnosing mHE have limited value for predicting HE after TIPS insertion. We could not find evidence that TIPS insertion leads to a psychometric decline in the long term. IMPACT AND IMPLICATIONS: This prospective observational study compared three diagnostic tests for mHE and showed the limited value of these tests for predicting overt HE in patients with cirrhosis undergoing TIPS insertion. In addition, the results suggest that cognitive performance generally remains stable after TIPS insertion. These results are important for physicians and researchers involved in the management of patients with cirrhosis undergoing TIPS procedures. The study's findings serve as a starting point for further investigations on the development of more effective strategies for predicting and managing post-TIPS HE. CLINICAL TRIAL NUMBER: ClinicalTrials.gov NCT04801290.
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spelling pubmed-104328042023-08-18 Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests Ehrenbauer, Alena F. Schneider, Hannah Stockhoff, Lena Tiede, Anja Lorenz, Charlotte Dirks, Meike Witt, Jennifer Gabriel, Maria M. Wedemeyer, Heiner Hinrichs, Jan B. Weissenborn, Karin Maasoumy, Benjamin JHEP Rep Research Article BACKGROUND & AIMS: Hepatic encephalopathy (HE) is a frequent and severe complication in patients after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for post-TIPS HE remain poorly defined. Minimal HE (mHE) is a well-known risk factor for overt HE in patients with cirrhosis without TIPS. We aimed to evaluate three tools frequently used for diagnosing mHE for their dynamic changes and their predictive value for overt HE after TIPS. METHODS: We prospectively recruited 84 consecutive patients before TIPS insertion and monitored them for 180 days for post-TIPS HE. Before TIPS insertion, the patients underwent the portosystemic encephalopathy (PSE) syndrome test, the animal naming test (ANT), and the critical flicker frequency (CFF). Patients were retested after TIPS insertion. RESULTS: The majority of patients were male (67.9%), and the predominant indication for TIPS was refractory ascites (75%). Median age was 59 years, model for end-stage liver disease score was 12, and 66.3%, 64.6%, and 28.4% patients had evidence for mHE according to the PSE syndrome test, ANT, and CFF, respectively. Overall, 25 patients developed post-TIPS HE within 180 days after TIPS insertion. Post-TIPS incidence of overt HE was 22.2, 28.6, 45.5, and 55.6% in those with no, one, two, and three pathological tests at baseline, respectively. However, none of the three tests was significantly associated with post-TIPS HE. Of note, mean performance in all tests remained stable over time after TIPS insertion. CONCLUSIONS: PSE syndrome test, ANT and CFF, which are frequently used for diagnosing mHE have limited value for predicting HE after TIPS insertion. We could not find evidence that TIPS insertion leads to a psychometric decline in the long term. IMPACT AND IMPLICATIONS: This prospective observational study compared three diagnostic tests for mHE and showed the limited value of these tests for predicting overt HE in patients with cirrhosis undergoing TIPS insertion. In addition, the results suggest that cognitive performance generally remains stable after TIPS insertion. These results are important for physicians and researchers involved in the management of patients with cirrhosis undergoing TIPS procedures. The study's findings serve as a starting point for further investigations on the development of more effective strategies for predicting and managing post-TIPS HE. CLINICAL TRIAL NUMBER: ClinicalTrials.gov NCT04801290. Elsevier 2023-06-28 /pmc/articles/PMC10432804/ /pubmed/37600959 http://dx.doi.org/10.1016/j.jhepr.2023.100829 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Article
Ehrenbauer, Alena F.
Schneider, Hannah
Stockhoff, Lena
Tiede, Anja
Lorenz, Charlotte
Dirks, Meike
Witt, Jennifer
Gabriel, Maria M.
Wedemeyer, Heiner
Hinrichs, Jan B.
Weissenborn, Karin
Maasoumy, Benjamin
Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests
title Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests
title_full Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests
title_fullStr Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests
title_full_unstemmed Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests
title_short Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests
title_sort predicting overt hepatic encephalopathy after tips: value of three minimal hepatic encephalopathy tests
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10432804/
https://www.ncbi.nlm.nih.gov/pubmed/37600959
http://dx.doi.org/10.1016/j.jhepr.2023.100829
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