Risk Factors Of Overt Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt

Objectives Through the follow-up study of patients with portal hypertension treated by transjugular intrahepatic portosystemic shunt（TIPS）,the related factors of one-year incidence of overt hepatic encephalopathy（OHE）after TIPS were compared and analyzed,and the independent risk factors of one-year incidence of OHE after TIPS were screened out,The prediction model of OHE after TIPS was established by multiple regression analysis.The model was used for preoperative evaluation to screen the suitable population for TIPS;In patients with high risk of OHE after TIPS,preventive treatment should be taken to reduce the risk of OHE after operation.Methods Between January 2010 and November 2019,562 patients who hospitalized in Shandong provincial hospital affiliated to Shandong university were included in our study,those patients were diagnosed with cirrhosis,and developed portal hypertension;among them,440 patients met the inclusion criteria,77 patients had incomplete data,and 97 patients were lost to follow-up.At last,266 patients were included in this study.The patients were divided into non hepatic encephalopathy group（n=181）and hepatic encephalopathy group（n=85）according to the occurrence of hepatic encephalopathy within 1 year after TIPS.The relevant data of patients before and after TIPS were collected,including age,gender,etiology,history of hepatic encephalopathy,preoperative portal vein pressure,postoperative portal vein pressure,the difference between preoperative and postoperative portal vein pressure,percentage of portal pressure decrease,preoperative presence or absence of portal thrombosis,preoperative presence or absence of ascites and degree of ascites,varicose vein type,preoperative laboratory examination indexes（AST,alt,ALB,TBIL,TC,HDL,LDL,TG,serum creatinine,serum potassium,sodium,Pt,INR,WBC,Hb,PLT）,Child Pugh grade,MELD（Na）score,diuretic using,anticoagulants,probiotics and antibiotics.Data analysis were carried out by spss21.0.P<0.05 is considered to have significant statistical significance.Results Among the 266 patients included in this study,85 patients developed overt hepatic encephalopathy within one year,and the incidence of OHE was 31.95%（85/266）.The univariate analysis results reveal that differences in age and ascites were statistically significant,diuretic use,AST,ALT,white blood cells,platelets,triglyceride,rate of portal vein pressure decreased before and after TIPS between hepatic encephalopathy group and non hepatic encephalopathy group.The results of multifactor analysis showed that age and diuretic use were independent risk factors for the occurrence of OHE within one year after transjugular intrahepatic portosystemic shunt.According to these indicators,the prediction model of hepatic encephalopathy within one year after TIPS was established.The specific formula was:logit（P）=-2.978+0.033*age+0.783*diuretic（none=0,diuretic used=1）,156,P<0.001,and the patients with score>0.2729 had higher risk of hepatic encephalopathy within one year.The accuracy was 69.9%.Conclusion:Age and diuretic use are independent risk factors for overt hepatic encephalopathy within one year after TIPS.The predictive model of hepatic encephalopathy after TIPS[logit（P）=-2.978+0.033*age+0.783*diuretic（none=0,used diuretic=1）]had certain predictive value for the risk ofovert hepatic encephalopathy within one year after TIPS.Preoperative evaluation of patients can screen the suitable population for TIPS,and postoperative treatment and prevention of high-risk patients with overt hepatic encephalopathy can be guided.