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Volume 36 Issue 2
Feb.  2020
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Article Navigation >  Journal of Clinical Hepatology  > 2020  >  36(2): 343-347

Risk factors for hepatic encephalopathy after emergency transjugular intrahepatic portosystemic shunt for patients with acute esophagogastric variceal bleeding

DOI: 10.3969/j.issn.1001-5256.2020.02.022

  • Department of Infectious Diseases/Intensive Care Unit of Hepatology,The First Hospital Affiliated of Soochow University

Research funding:

 

  • Received Date: 2019-09-18
  • Published Date: 2020-02-20
    Abstract

  • Objective To investigate the risk factors for hepatic encephalopathy( HE) after emergency transjugular intrahepatic portosystemic shunt( TIPS) for patients with acute esophagogastric variceal bleeding( EVB) based on an analysis of clinical outcomes. Methods A retrospective analysis was performed for the clinical data of 93 patients with decompensated liver cirrhosis and acute EVB who failed endoscopy or medication and then underwent TIPS with a covered stent within 72 hours in The First Affiliated Hospital of Soochow University from January 2013 to December 2018. According to the presence or absence of HE after surgery,they were divided into HE group with 36 patients and non-HE group with 57 patients. Preoperative clinical data were collected,including sex,age,etiology,comorbidities,and blood biochemical parameters [white blood cell count( WBC),platelet count( PLT),hematocrit( Hct),total bilirubin( TBil),aspartate aminotransferase( AST),albumin( Alb),serum creatinine( SCr),and prothrombin time( PT) ],and the measured values were used to calculate Model for End-Stage Liver Disease( MELD) score. Wedged hepatic venous pressure( WHVP) and free hepatic venous pressure( FHVP) were measured and recorded before TIPS stent implantation,and hepatic venous pressure gradient( HVPG) was the difference between WHVP and FHVP. The t-test or the Mann-Whitney U test was used for comparison between two groups,and the chi-square test was used for comparison of categorical data between two groups. A binary logistic regression analysis was used to identify the risk factors for the prognosis of patients after TIPS. Results The incidence rate of postoperative HE was 38. 710%. There were significant differences between the two groups in preoperative MELD score( 13. 000 ± 3. 189 vs 11. 684 ± 2. 068,t = 2. 068,P = 0. 043) and HVPG( 24. 908 ±5. 317 mm Hg vs 22. 597 ± 4. 928 mm Hg,t = 2. 100,P = 0. 039). Based on the results of HE grading,17 patients( 47. 222%) had grade0-1 HE,9( 25. 000%) had grade 2 HE,6( 16. 667%) had grade 3 HE,and 4( 11. 111%) had grade 4 HE. The stepwise logistic regression analysis showed that MELD score( odds ratio [OR]= 0. 803,95% confidence interval [CI]: 0. 679-0. 948,P = 0. 010) and HVPG( OR = 0. 896,95% CI: 0. 816-0. 984,P = 0. 022) were independent risk factors for HE after TIPS. Conclusion There is a high incidence rate of HE after emergency TIPS for acute EVB,and preoperative MELD score and HVPG can predict the risk of HE after TIPS.

     

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