Changes Of Body Composition In Patients After TIPS And Its Relationship With Hepatic Encephalopathy

Objective:To observe the dynamic changes of body composition after TIPS in different populations,and explore the relationship between the changes and hepatic encephalopathy,so as to provide clinical guidance for the prevention of hepatic encephalopathy after TIPS in cirrhotic portal vein patients.Methods:Ninety-four patients with portal hypertension who received TIPS at the First Hospital of Shanxi Medical University between January 2020 and January 2022 were included.We collected blood biochemical indexes of patients 3 days before surgery,Weight,height,skeletal muscle area(SMA),subcutaneous fat area(SFA)and right psoas major muscle thickness(TPMT)were measured before surgery and at 3,6 and 12 months after surgery.And calculate the skeletal muscle index(SMI).The general estimation equation was used to analyze the dynamic changes of body composition after operation.According to the change degree of skeletal muscle area,they were divided into low improvement group(SMA improvement≤6.8%)and high improvement group(SMA improvement>6.8%).Logistic regression was used to test the relationship between the degree of skeletal muscle change after TIPS and the risk of developing dominant hepatic encephalopathy(OHE)in different models.Logistic regression,Kaplan-Meier method and receiver operating characteristic curve(ROC)were used to explore its relationship with postoperative dominant hepatic encephalopathy.Results:In 94 patients,TPMT increased by 1.5(0.3,3.8)mm,SMA increased by 6.8(1.3,19.2)cm~2,SFA increased by 17.3(6.3,32.2)cm~2,and SMI increased by 3.5±4.9cm~2/m~2.Patients with sarcopenia,better liver function(grade A and B),and no OHE had greater changes in body composition after surgery.The postoperative SMA and SFA in patients with sarcopenia(N=67)increased by 12.0±13.4cm~2and 18.2(7.5,32.7)cm~2,which was more significant than that in patients without sarcopenia[4.0±11.8cm~2,9.7(-5.7,32.1)cm~2](P=0.009,P=0.040).After TIPS,no-OHE patients(N=61)had an increase of 11.8(5.4,20.9)cm~2,and improvement of 11.1%in SMA compared with patients with OHE[SMA increased by 2.0(-0.4,7.3)cm~2 and 1.6%],P=0.001,P=0.003.According to the degree of improvement of skeletal muscle area,they were divided into low improvement group(SMA improvement≤6.8%)and high improvement group(SMA improvement>6.8%).Compared with patients in the low-improvement group,patients in the high-improvement group(SMA improvement>6.8%)had a lower incidence of OHE attacks during follow-up(52.1%vs 17.4%,P<0.001).Logistic regression showed that after adjusting for different covariates,skeletal muscle improvement was negatively correlated with the risk of OHE(OR=0.951,P=0.010),and compared with SMA≤6.8%group,The risk of OHE was 5.163-fold higher in SMA>6.8%group(OR=5.163,P=0.001).Conclusion:Our study showed that skeletal muscle area and subcutaneous fat area increased after TIPS in cirrhotic portal hypertension patients.Indicating a reversal of muscle and fat.The changes were more significant in patients with non-OHE,sarcopenia and better liver function.Improvements in skeletal muscle mass after TIPS are associated with OHE occurrence:The greater the degree of improvement,the lower the risk of OHE,and an improvement in skeletal muscle mass of<6.8%was an independent risk factor for OHE after TIPS.Postoperative intervention of muscle mass may be an effective measure to prevent OHE.