Value of indocyanine green retention rate at 15 minutes in predicting the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in liver cancer patients with portal hypertension

Objective To investigate the clinical value of indocyanine green retention rate at 15 minutes( ICG-R15),Child-Turcotte-Pugh( CTP) class,and Model for End-Stage Liver Disease( MELD) score in predicting post-transjugular intrahepatic portosystemic shunt( TIPS) hepatic encephalopathy( HE) in liver cancer patients with portal hypertension. Methods A retrospective analysis was performed for the clinical data of 95 liver cancer patients with portal hypertension who underwent TIPS in Department of Interventional Therapy in Beijing Shijitan Hospital from January 2015 to June 2017,and according to the presence or absence of HE after TIPS,they were divided into HE group with 24 patients and non-HE group with 71 patients. ICG-R15,CTP class,and MELD score were determined for all patients before surgery. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for HE after TIPS,and the receiver operating characteristic( ROC) curve was used to analyze the value of ICG-R15,CTP class,and MELD score in predicting HE. Results The incidence rate of HE was 25. 2%( 24/95) within 12 months after TIPS. The univariate analysis showed that stent location( P = 0. 021),ICG-R15( P = 0. 005),and CTP class( P = 0. 040) were associated with HE after TIPS. The multivariate analysis showed that stent located in the right portal vein( OR = 3. 373,95% CI: 2. 346 ～ 5. 103,P = 0. 010) and ICG-R15 > 30%( OR = 2. 107,95% CI: 1. 331 ～ 3. 212,P = 0. 036) were independent risk factors for HE after TIPS in liver cancer patients with portal hypertension. The ROC curve analysis showed that ICG-R15,MELD score,and CTP class had an area under the ROC curve of 0. 659,0. 638,and 0. 621,respectively,in predicting HE after TIPS. Conclusion ICG-R15 has a certain clinical value in predicting HE after TIPS in liver cancer patients with portal hypertension.