Predictors of hepatic encephalopathy in cirrhotic patients undergoing elective transjugular intrahepatic portosystemic shunt.

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Conference Proceeding

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Background: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is used for the management of patients with complications related to portal hypertension. A significant post-TIPS complication is new or worsening hepatic encephalopathy (HE), occurring in up to 35% of patients; thus, appropriate patient selection is critical. Previous studies suggest age, prior HE, Child-Pugh (CPS) and MELD scores to be predictive of post-TIPS HE. The purpose of this study was to identify significant predictors of HE development in patients undergoing elective TIPS procedure and develop a model to risk stratify potential candidates. Methods: Cirrhotic patients who underwent elective TIPS placement between 1/2004-6/2016 with at least 1-year follow-up were included, yielding 95 patients. Relevant data collected retrospectively included: patient demographics, TIPS indication, etiology of cirrhosis, albumin, platelets, creatinine, bilirubin, INR, sodium, pre-TIPS MELD, MELD-Na, CPS, pre-and post-TIPS portosystemic gradient, pre-TIPS benzodiazepine or opiate use (BZDO), pre-TIPS HE occurrence, and post-TIPS HE frequency, as well as severity by West Haven criteria. T-test analysis was used for continuous variables and Chi-square tests for categorical variables, while multiple logistic regression model was performed using stepwise variable selection. Results: 95 elective TIPS were performed in 38 females and 57 males with a mean age of 55. HE occurred in 39% (37/95) of patients within 1-year post-procedure, 9% (9/95) of whom had clinically severe HE (defined as grade III or IV). Univariate analysis showed albumin13 (p17 (p10 (p



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