Risk factors for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement in cirrhotic patients

Introduction: Hepatic encephalopathy (HE) is a frequent consequence of transjugular intrahepatic portosystemic shunt (TIPS) placement and a major cause of morbidity, mortality and healthcare utilization in cirrhotic patients. The prevention of post-TIPS HE is mainly achieved by a careful selection of patients before the procedure. A relationship between the occurrence of HE and a low post-TIPS hepatic venous pressure gradient (HVPG) has been shown, suggesting that a large diversion of the blood from the liver poses as a risk factor for this complication. However, no studies have investigated the association between degree of HVPG reduction and development of post-TIPS HE. This study proposes to address a void for predicting post-TIPS HE. We hypothesize that there exists a relative magnitude in the reduction of HVPG after TIPS placement in cirrhotic patients with complications of portal hypertension that is associated with increased risk of post-TIPS HE. The aim of the present study is to determine (1) the prevalence of post-TIPS HE among patients who have undergone TIPS procedure at Oregon Health & Science University (OHSU) from 2002-2012, (2) the degree of HPVG reduction post-TIPS that is associated with an increased risk of HE, and (3) other factors associated with post-TIPS HE. Methods: This is a retrospective cohort study, and data are obtained through chart reviews of the electronic medical record, EPIC. Subjects are drawn from a group of cirrhotic patients who underwent TIPS procedure at OHSU as documented by Department of Interventional Radiology between June 2003 and October 2012. The outcome of interest is the frequency of clinically evident HE within 30 days after TIPS placement. Demographic, clinical, biochemical and hepatic hemodynamic characteristics of all subjects were analyzed. The effect measure for degree of HVPG reduction on post-TIPS HE was calculated using multivariable logistic regression analysis, adjusting