Transjugular Intrahepatic Portosystemic Shunt Related Hepatic Encephalopathy in Cirrhotics With Refractory Ascites: Incidence and Correlation With TIPS Stent Diameter and Pre-TIPS Sarcopenia

Abstract

Objectives

Aims of this study were to compare the incidence of hepatic encephalopathy (HE) in 8 mm and 10 mm transjugular intrahepatic portosystemic shunt (TIPS) stent, the predictive factors for HE, and to assess the change in muscle quantity and quality after TIPS.

Methods

A retrospective cross-sectional study of patients who underwent elective TIPS placement between 2012 and 2022 was conducted. A total of 535 patients were assessed for eligibility, of which 253 patients were excluded and 282 were included for analysis. HE was defined based on predefined criteria and the incidence was calculated. Parameters in HE and non-HE groups were compared to identify predictive factors, and predictive models were developed.

Results

Complete or near-complete resolution of ascites was significantly higher (P-value 0.005) and stent block or dysfunction requiring reintervention was lower with 10 mm stent (P-value 0.005). However, the incidence of HE was higher in 10 mm (49/282, 63.6%) as compared to 8 mm group (28/282, 36.4%) (P-value 0.459; nonsignificant). Patients with post-TIPS HE had low skeletal muscle index (SMI), psoas muscle index (PMI), and psoas muscle attenuation (PMA) (P < 0.001) while intramuscular attenuation coefficient (IMAC) was high (P < 0.001). There was significant improvement in SMI, PMI, and PMA after TIPS, while IMAC and liver stiffness measurement (LSM) showed a significant decrease. PMI, PMA, history of prior HE, and Model For End-Stage Liver Disease (MELD) were identified as independent predictors for HE. A model was devised based on these parameters with a predictive value of 71.3 percent.

Conclusion

10 mm-TIPS stent was associated with better ascites control at the cost of an increased incidence of HE. Prediction for post-TIPS HE may be done using PMI, PMA, history of prior HE, and MELD. TIPS may lead to improvement in the status of muscle quantity and quality, thus reducing the probability of HE.