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

被引:16
作者
Ehrenbauer, Alena F. [1 ]
Schneider, Hannah [1 ]
Stockhoff, Lena [1 ]
Tiede, Anja [1 ]
Lorenz, Charlotte [1 ]
Dirks, Meike [2 ]
Witt, Jennifer
Gabriel, Maria M. [2 ]
Wedemeyer, Heiner [1 ]
Hinrichs, Jan B. [3 ]
Weissenborn, Karin [2 ]
Maasoumy, Benjamin [1 ]
机构
[1] Hannover Med Sch, Dept Gastroenterol Hepatol Infect Dis & Endocrinol, Hannover, Germany
[2] Hannover Med Sch, Dept Neurol, Hannover, Germany
[3] Hannover Med Sch, Inst Diagnost & Intervent Radiol, Hannover, Germany
关键词
Liver cirrhosis; Hepatic encephalopathy; Transjugular intrahepatic por-tosystemic shunt; TIPS; PSE syndrome test; Animal naming test; Critical flicker frequency; CRITICAL FLICKER FREQUENCY; INTRAHEPATIC PORTOSYSTEMIC SHUNTS; TRANSPLANT-FREE SURVIVAL; REFRACTORY ASCITES; CIRRHOSIS; DIAGNOSIS; LIFE;
D O I
10.1016/j.jhepr.2023.100829
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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. (c) 2023 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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页数:10
相关论文
共 52 条
[1]   Minimal Hepatic Encephalopathy Impairs Quality of Life [J].
Agrawal, Swastik ;
Umapathy, Sridharan ;
Dhiman, Radha K. .
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY, 2015, 5 :S42-S48
[2]   Minimal hepatic encephalopathy identifies patients at risk of faster cirrhosis progression [J].
Ampuero, Javier ;
Montoliu, Carmina ;
Simon-Talero, Macarena ;
Aguilera, Virginia ;
Millan, Raquel ;
Marquez, Celina ;
Jover, Rodrigo ;
Carmen Rico, Maria ;
Sendra, Carmen ;
Angel Serra, Miguel ;
Romero-Gomez, Manuel .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2018, 33 (03) :718-725
[3]   TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites: An updated meta-analysis [J].
Bai, Ming ;
Qi, Xing-Shun ;
Yang, Zhi-Ping ;
Yang, Man ;
Fan, Dai-Ming ;
Han, Guo-Hong .
WORLD JOURNAL OF GASTROENTEROLOGY, 2014, 20 (10) :2704-2714
[4]   Pre-Transjugular Intrahepatic Portosystemic Shunts (TIPS) Prediction of Post-TIPS Overt Hepatic Encephalopathy: The Critical Flicker Frequency Is More Accurate Than Psychometric Tests [J].
Berlioux, Pierre ;
Robic, Marie Angele ;
Poirson, Helene ;
Metivier, Sophie ;
Otal, Philippe ;
Barret, Carine ;
Lopez, Frederic ;
Peron, Jean Marie ;
Vinel, Jean Pierre ;
Bureau, Christophe .
HEPATOLOGY, 2014, 59 (02) :622-629
[5]   Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival [J].
Bettinger, Dominik ;
Sturm, Lukas ;
Pfaff, Lena ;
Hahn, Felix ;
Kloeckner, Roman ;
Volkwein, Lara ;
Praktiknjo, Michael ;
Lv, Yong ;
Han, Guohong ;
Huber, Jan Patrick ;
Boettler, Tobias ;
Reincke, Marlene ;
Klinger, Christoph ;
Caca, Karel ;
Heinzow, Hauke ;
Seifert, Leon Louis ;
Weiss, Karl Heinz ;
Rupp, Christian ;
Piecha, Felix ;
Kluwe, Johannes ;
Zipprich, Alexander ;
Luxenburger, Hendrik ;
Neumann-Haefelin, Christoph ;
Schmidt, Arthur ;
Jansen, Christian ;
Meyer, Carsten ;
Uschner, Frank E. ;
Brol, Maximilian J. ;
Trebicka, Jonel ;
Rossle, Martin ;
Thimme, Robert ;
Schultheiss, Michael .
JOURNAL OF HEPATOLOGY, 2021, 74 (06) :1362-1372
[6]   Critical Flicker Frequency as a Marker of Hepatic Encephalopathy in Patients before and after Transjugular Intrahepatic Portosystemic Shunt [J].
Biecker, Erwin ;
Hausdoerfer, Iris ;
Gruenhage, Frank ;
Strunk, Holger ;
Sauerbruch, Tilman .
DIGESTION, 2011, 83 (1-2) :24-31
[7]   The Use of Rifaximin in the Prevention of Overt Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt A Randomized Controlled Trial [J].
Bureau, Christophe ;
Thabut, Dominique ;
Jezequel, Caroline ;
Archambeaud, Isabelle ;
D'Alteroche, Louis ;
Dharancy, Sebastien ;
Borentain, Patrick ;
Oberti, Frederic ;
Plessier, Aurelie ;
De Ledinghen, Victor ;
Ganne-Carrie, Nathalie ;
Carbonell, Nicolas ;
Rousseau, Vanessa ;
Sommet, Agnes ;
Peron, Jean Marie ;
Vinel, Jean Pierre .
ANNALS OF INTERNAL MEDICINE, 2021, 174 (05) :633-+
[8]   Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites [J].
Bureau, Christophe ;
Thabut, Dominique ;
Oberti, Frederic ;
Dharancy, Sebastien ;
Carbonell, Nicolas ;
Bouvier, Antoine ;
Mathurin, Philippe ;
Otal, Philippe ;
Cabarrou, Pauline ;
Peron, Jean Marie ;
Vinel, Jean Pierre .
GASTROENTEROLOGY, 2017, 152 (01) :157-163
[9]   The Animal Naming Test: An Easy Tool for the Assessment of Hepatic Encephalopathy [J].
Campagna, Francesca ;
Montagnese, Sara ;
Ridola, Lorenzo ;
Senzolo, Marco ;
Schiff, Sami ;
De Rui, Michele ;
Pasquale, Chiara ;
Nardelli, Silvia ;
Pentassuglio, Ilaria ;
Merkel, Carlo ;
Angeli, Paolo ;
Riggio, Oliviero ;
Amodio, Piero .
HEPATOLOGY, 2017, 66 (01) :198-208
[10]  
García-Pagán JC, 2020, JHEP REP, V2, DOI 10.1016/j.jhepr.2020.100122