Construction of a risk prediction model for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension

Lanjing WANG; Jianping QIN; Xin YAO; Qi QI; Lin LIU; Shanhong TANG

doi:10.12449/JCH240613

Volume 40 Issue 6

Jun. 2024

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2024 > 40(6): 1149-1155

PDF( 915 KB)

Construction of a risk prediction model for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension

DOI: 10.12449/JCH240613

Lanjing WANG^{1, 2},
Jianping QIN²,
Xin YAO²,
Qi QI²,
Lin LIU²,
Shanhong TANG^{1, 2
,
,
,}

1.
Department of Gastroenterology，The Affiliated Hospital of Southwest Medical University，Luzhou，Sichuan 646099，China
2.
Department of Gastroenterology，The General Hospital of Western Theater Command，Chengdu 610083，China

Research funding:

Project of Sichuan Provincial Administration of Traditional Chinese Medicine (2023MS458)

More Information

Corresponding author: TANG Shanhong， tangshanhong@swjtu.edu.cn （ORCID： 0000-0001-6652-2942）
Received Date: 2023-09-01
Accepted Date: 2023-09-19
Published Date: 2024-06-25

Abstract

Abstract

Objective To investigate the influencing factors for overt hepatic encephalopathy （OHE） in patients with hepatitis B cirrhosis after transjugular intrahepatic portosystemic shunt （TIPS）， and to construct an individualized risk prediction model. Methods A total of 302 patients with hepatitis B cirrhosis who underwent TIPS in Department of Gastroenterology， The General Hospital of Western Theater Command， from January 2017 to December 2021 were enrolled， and according to the presence or absence of OHE after surgery， they were divided into non-OHE group with 237 patients and OHE group with 65 patients. The two groups were compared in terms of general data， laboratory markers， Child-Turcotte-Pugh （CTP） score， MELD combined with serum sodium concentration （MELD-Na） score， and albumin-bilirubin （ALBI） score before surgery. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate logistic regression analyses were used to identify the influencing factors for OHE after TIPS in patients with hepatitis B cirrhosis， and independent influencing factors were used to construct a nomogram model. The receiver operating characteristic （ROC） curve analysis and the calibration curve analysis were used to evaluate the discriminatory ability and calibration of the model， and the decision curve analysis and the clinical impact curve （CIC） were used to evaluate the clinical effectiveness of the model. Results Age （odds ratio ［OR］=1.035， 95% confidence interval ［CI］： 1.004‍ ‍—‍ ‍1.066， P<0.05）， white blood cell count （WBC）/platelet count （PLT） ratio （OR=33.725， 95%CI： 1.220‍ ‍—‍ ‍932.377， P<0.05）， international normalized ratio （INR）（OR=5.149， 95%CI： 1.052‍ ‍—‍ ‍25.207， P<0.05）， and pre-albumin （PAB）（OR=0.992， 95%CI： 0.983‍ ‍—‍ ‍1.000， P<0.05） were independent predictive factors for OHE after TIPS in patients with hepatitis B cirrhosis. The nomogram model constructed based on age， WBC/PLT ratio， INR， and PAB had an area under the ROC curve of 0.716 （95%CI： 0.649‍ ‍—‍ ‍0.781）， with a sensitivity of 78.5% and a specificity of 56.1%. Conclusion The nomogram model constructed based on age， WBC/PLT ratio， INR， and PAB can help to predict the risk of OHE after TIPS in patients with hepatitis B cirrhosis.
- Liver Cirrhosis,
- Hypertension， Portal,
- Portasystemic Shunt， Transjugular Intrahepatic,
- Hepatic Encephalopathy,
- Nomograms

FullText(HTML)

References(21)

References

[1]	SHAN S, ZHAO LH, MA H, et al. Definition, etiology, and epidemiology of liver cirrhosis[J]. J Clin Hepatol, 2021, 37( 1): 14- 16. DOI: 10.3969/j.issn.1001-5256.2021.01.003. 单姗, 赵连晖, 马红, 等. 肝硬化的定义、病因及流行病学[J]. 临床肝胆病杂志, 2021, 37( 1): 14- 16. DOI: 10.3969/j.issn.1001-5256.2021.01.003.
[2]	ZHANG K, LIU JL, LIU YL, et al. Clinical observation on the treatment of portal hypertension complicated with gastrointestinal bleeding due to cirrhosis by transjugular intrahepatic portosystemic shunt guided by 3D model constructed by computer based on CT thin-layer scanning data[J]. Clin J Med Off, 2023, 51( 6): 655- 656, 660. DOI: 10.16680/j.1671-3826.2023.06.28. 张凯, 刘晶磊, 刘燚隆, 等. 应用CT薄层扫描数据电脑构建3D模型指导经颈静脉肝内门体分流术治疗肝硬化门脉高压合并消化道出血临床效果观察[J]. 临床军医杂志, 2023, 51( 6): 655- 656, 660. DOI: 10.16680/j.1671-3826.2023.06.28.
[3]	WANG LJ, YAO X, QI Q, et al. Prevention and treatment of hepatic encephalopathy during the perioperative period of transjugular intrahepatic portosystemic shunt[J]. World J Gastrointest Surg, 2023, 15( 8): 1564- 1573. DOI: 10.4240/wjgs.v15.i8.1564.
[4]	LIU SY, LI LH, LI SX, et al. Predictive value of controlled nutritional status score for overt hepatic encephalopathy after transjugular intrahepatic portosystemic stent-shunt of Budd-Chiari syndrome[J]. Chin J Dig Surg, 2023, 22( 2): 260- 267. DOI: 10.3760/cma.j.cn115610-20221205-00733. 刘胜炎, 李路豪, 李素新, 等. 控制营养状况评分对布-加综合征患者行经颈静脉肝内门腔内支架分流术后发生显性肝性脑病的预测价值[J]. 中华消化外科杂志, 2023, 22( 2): 260- 267. DOI: 10.3760/cma.j.cn115610-20221205-00733.
[5]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006. 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
[6]	RUNYON BA, AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J]. Hepatology, 2013, 57( 4): 1651- 1653. DOI: 10.1002/hep.26359.
[7]	The Chinese College of Interventionalists. CCI clinical practice guidelines: Management of TIPS for portal hypertension(2019 edition)[J]. J Clin Hepatol, 2019, 35( 12): 2694- 2669. DOI: 10.3969/j.issn.1001-5256.2019.12.010. 中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35( 12): 2694- 9. DOI: 10.3969/j.issn.1001-5256.2019.12.010.
[8]	Group of Gastrointestinal Intervention, Chinese Society of Gastroenterology, Chinese Medical Association. Consensus on transjugular intrahepatic portosystemic shunt for treatment of cirrhotic portal hypertension[J]. J Clin Hepatol, 2014, 30( 3): 210- 213. DOI: 10.3969/j.issn.1001-5256.2014.03.003. 中华医学会消化病学分会消化介入学组. 经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见[J]. 临床肝胆病杂志, 2014, 30( 3): 210- 213. DOI: 10.3969/j.issn.1001-5256.2014.03.003.
[9]	QIN JP, TANG SH, JIANG MD, et al. Contrast enhanced computed tomography and reconstruction of hepatic vascular system for transjugular intrahepatic portal systemic shunt puncture path planning[J]. World J Gastroenterol, 2015, 21( 32): 9623- 9629. DOI: 10.3748/wjg.v21.i32.9623.
[10]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34( 10): 2076- 2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007. 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34( 10): 2076- 2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.
[11]	VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60( 2): 715- 735. DOI: 10.1002/hep.27210.
[12]	THABUT D, BOUZBIB C, MEUNIER L, et al. Diagnosis and management of hepatic encephalopathy: The French recommendations[J]. Liver Int, 2023, 43( 4): 750- 762. DOI: 10.1111/liv.15510.
[13]	BOIKE JR, THORNBURG BG, ASRANI SK, et al. North American practice-based recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension[J]. Clin Gastroenterol Hepatol, 2022, 20( 8): 1636- 1662. e 36. DOI: 10.1016/j.cgh.2021.07.018.
[14]	LI YL, PANG HJ, HE XF. Establishment and validation of nomogram in patients with early hepatic encephalopathy after TIPS[J]. J Pract Med, 2020, 36( 7): 963- 968. DOI: 10.3969/j.issn.1006-5725.2020.07.026. 李应龙, 庞桦进, 何晓峰. 经颈静脉肝内门腔静脉分流术后早期肝性脑病列线图的建立和验证[J]. 实用医学杂志, 2020, 36( 7): 963- 968. DOI: 10.3969/j.issn.1006-5725.2020.07.026.
[15]	LIU F, CAI LY, ZHONG L, et al. Model for end-stage liver disease combined with serum prealbumin to predict the prognosis of patients with decompensated liver cirrhosis[J]. J Dig Dis, 2010, 11( 6): 352- 357. DOI: 10.1111/j.1751-2980.2010.00465.x.
[16]	NARDELLI S, LATTANZI B, TORRISI S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement[J]. Clin Gastroenterol Hepatol, 2017, 15( 6): 934- 936. DOI: 10.1016/j.cgh.2016.10.028.
[17]	AMODIO P, BEMEUR C, BUTTERWORTH R, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus[J]. Hepatology, 2013, 58( 1): 325- 336. DOI: 10.1002/hep.26370.
[18]	LI JN, DU MH, LI H, et al. Low prealbumin levels were associated with increased frequency of hepatic encephalopathy in hepatitis B virus(HBV)-related decompensated cirrhosis[J]. Med Sci Monit, 2023, 29: e937772. DOI: 10.12659/MSM.937772.
[19]	CHATTERJEE M, GEISLER T. Inflammatory contribution of platelets revisited: New players in the arena of inflammation[J]. Semin Thromb Hemost, 2016, 42( 3): 205- 214. DOI: 10.1055/s-0035-1570081.
[20]	AFDHAL N, MCHUTCHISON J, BROWN R, et al. Thrombocytopenia associated with chronic liver disease[J]. J Hepatol, 2008, 48( 6): 1000- 1007. DOI: 10.1016/j.jhep.2008.03.009.
[21]	RAWI S, WU GY. Pathogenesis of thrombocytopenia in chronic HCV infection: A review[J]. J Clin Transl Hepatol, 2020, 8( 2): 184- 191. DOI: 10.14218/JCTH.2020.00007.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(5) / Tables(4)

Get Citation

PDF

XML

Article Metrics

Article views (57) PDF downloads(15)

Construction of a risk prediction model for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension

DOI: 10.12449/JCH240613

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Construction of a risk prediction model for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension

DOI: 10.12449/JCH240613

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content