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 pa...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | JHEP Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S258955592300160X |
| _version_ | 1797732876286951424 |
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| author | Alena F. Ehrenbauer Hannah Schneider Lena Stockhoff Anja Tiede Charlotte Lorenz Meike Dirks Jennifer Witt Maria M. Gabriel Heiner Wedemeyer Jan B. Hinrichs Karin Weissenborn Benjamin Maasoumy |
| author_facet | Alena F. Ehrenbauer Hannah Schneider Lena Stockhoff Anja Tiede Charlotte Lorenz Meike Dirks Jennifer Witt Maria M. Gabriel Heiner Wedemeyer Jan B. Hinrichs Karin Weissenborn Benjamin Maasoumy |
| author_sort | Alena F. Ehrenbauer |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-12T12:19:51Z |
| format | Article |
| id | doaj.art-a04086b2a6ed4d39a09b6e4a8590996d |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-03-12T12:19:51Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
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| series | JHEP Reports |
| spelling | doaj.art-a04086b2a6ed4d39a09b6e4a8590996d2023-08-30T05:54:41ZengElsevierJHEP Reports2589-55592023-09-0159100829Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy testsAlena F. Ehrenbauer0Hannah Schneider1Lena Stockhoff2Anja Tiede3Charlotte Lorenz4Meike Dirks5Jennifer Witt6Maria M. Gabriel7Heiner Wedemeyer8Jan B. Hinrichs9Karin Weissenborn10Benjamin Maasoumy11Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; Department of Neurology, Hannover Medical School, Hannover, GermanyDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, GermanyDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, GermanyDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, GermanyDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, GermanyDepartment of Neurology, Hannover Medical School, Hannover, GermanyDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, GermanyDepartment of Neurology, Hannover Medical School, Hannover, GermanyDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, GermanyInstitute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, GermanyDepartment of Neurology, Hannover Medical School, Hannover, GermanyDepartment of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; Corresponding author. Address: Hannover Medical School Carl-Neuberg-Str.1, 30625 Hannover, Germany. Tel.: +49 511 532 8757.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.http://www.sciencedirect.com/science/article/pii/S258955592300160XLiver cirrhosisHepatic encephalopathyTransjugular intrahepatic portosystemic shuntTIPSPSE syndrome testAnimal naming test |
| spellingShingle | Alena F. Ehrenbauer Hannah Schneider Lena Stockhoff Anja Tiede Charlotte Lorenz Meike Dirks Jennifer Witt Maria M. Gabriel Heiner Wedemeyer Jan B. Hinrichs Karin Weissenborn Benjamin Maasoumy Predicting overt hepatic encephalopathy after TIPS: Value of three minimal hepatic encephalopathy tests JHEP Reports Liver cirrhosis Hepatic encephalopathy Transjugular intrahepatic portosystemic shunt TIPS PSE syndrome test Animal naming test |
| 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 | Liver cirrhosis Hepatic encephalopathy Transjugular intrahepatic portosystemic shunt TIPS PSE syndrome test Animal naming test |
| url | http://www.sciencedirect.com/science/article/pii/S258955592300160X |
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