Lisa Sandmann, Julius F M Egge, Anja Tiede, Alena F Ehrenbauer, Martin A Kabelitz, Hannah Rieland, Jim B Mauz, Bernhard C Meyer, Heiner Wedemeyer, Karin Weissenborn, Benjamin Maasoumy
{"title":"血浆氨水平预测经颈静脉肝内门静脉系统分流术后肝性脑病。","authors":"Lisa Sandmann, Julius F M Egge, Anja Tiede, Alena F Ehrenbauer, Martin A Kabelitz, Hannah Rieland, Jim B Mauz, Bernhard C Meyer, Heiner Wedemeyer, Karin Weissenborn, Benjamin Maasoumy","doi":"10.1002/ueg2.70095","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension. Overt hepatic encephalopathy (oHE) is a complication after TIPS associated with increased morbidity. Elevated ratio of plasma ammonia (AMM) levels compared to the local upper limit of normal (ULN) has been associated with oHE, hepatic complications and increased mortality in patients with cirrhosis without TIPS. The role of AMM in risk stratification of post-TIPS oHE is unclear.</p><p><strong>Objective: </strong>To investigate the role of AMM in the prediction of oHE in patients receiving TIPS placement.</p><p><strong>Methods: </strong>Patients with TIPS placement were recruited within a prospective observational study protocol with follow-up (FU) visits at 1, 3, 6, and 12 months after TIPS. Post hoc analyses of AMM levels for the association with the primary (oHE) and secondary endpoints (hepatic decompensation, infections, death/liver transplantation) during the first year after TIPS placement were performed.</p><p><strong>Results: </strong>Of 188 patients with TIPS placement, 148 patients with available baseline AMM levels were included. During follow-up, 37% (55/148) of patients developed oHE. In multivariable competing risk analysis, baseline AMM/ULN (HR 2.03 [CI 1.42-2.89], p = 0.001) and Freiburg index of post-TIPS survival (FIPS) score (HR 1.52 [CI 1.03-2.24], p = 0.037) were independently associated with oHE. The published cut-off AMM/ULN > 1.4 showed comparable results (HR 2.40 [CI 1.24-4.65], p = 0.01). AMM at FU1 was available in 100 patients, of whom 28% (28/100) developed oHE after FU1. In multivariable competing risk analysis, AMM/ULN (HR 5.48 [CI 2.37-12.67], p < 0.001), psychometric hepatic encephalopathy score (HR 0.86 [0.78-0.96], p = 0.005) and FIPS (HR 3.57 [CI 1.79-7.14], p < 0.001) at FU1 were independently associated with oHE after FU1. No significant association between AMM/ULN and the secondary endpoints was detected.</p><p><strong>Conclusion: </strong>AMM levels before TIPS are independently associated with oHE after TIPS placement. AMM levels may serve as an additional marker for risk stratification of patients.</p><p><strong>Trial registration: </strong>Clinical trial number NCT04801290.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":"1171-1183"},"PeriodicalIF":6.7000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463689/pdf/","citationCount":"0","resultStr":"{\"title\":\"Plasma Ammonia Levels Predict Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.\",\"authors\":\"Lisa Sandmann, Julius F M Egge, Anja Tiede, Alena F Ehrenbauer, Martin A Kabelitz, Hannah Rieland, Jim B Mauz, Bernhard C Meyer, Heiner Wedemeyer, Karin Weissenborn, Benjamin Maasoumy\",\"doi\":\"10.1002/ueg2.70095\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension. Overt hepatic encephalopathy (oHE) is a complication after TIPS associated with increased morbidity. Elevated ratio of plasma ammonia (AMM) levels compared to the local upper limit of normal (ULN) has been associated with oHE, hepatic complications and increased mortality in patients with cirrhosis without TIPS. The role of AMM in risk stratification of post-TIPS oHE is unclear.</p><p><strong>Objective: </strong>To investigate the role of AMM in the prediction of oHE in patients receiving TIPS placement.</p><p><strong>Methods: </strong>Patients with TIPS placement were recruited within a prospective observational study protocol with follow-up (FU) visits at 1, 3, 6, and 12 months after TIPS. Post hoc analyses of AMM levels for the association with the primary (oHE) and secondary endpoints (hepatic decompensation, infections, death/liver transplantation) during the first year after TIPS placement were performed.</p><p><strong>Results: </strong>Of 188 patients with TIPS placement, 148 patients with available baseline AMM levels were included. During follow-up, 37% (55/148) of patients developed oHE. In multivariable competing risk analysis, baseline AMM/ULN (HR 2.03 [CI 1.42-2.89], p = 0.001) and Freiburg index of post-TIPS survival (FIPS) score (HR 1.52 [CI 1.03-2.24], p = 0.037) were independently associated with oHE. The published cut-off AMM/ULN > 1.4 showed comparable results (HR 2.40 [CI 1.24-4.65], p = 0.01). AMM at FU1 was available in 100 patients, of whom 28% (28/100) developed oHE after FU1. In multivariable competing risk analysis, AMM/ULN (HR 5.48 [CI 2.37-12.67], p < 0.001), psychometric hepatic encephalopathy score (HR 0.86 [0.78-0.96], p = 0.005) and FIPS (HR 3.57 [CI 1.79-7.14], p < 0.001) at FU1 were independently associated with oHE after FU1. No significant association between AMM/ULN and the secondary endpoints was detected.</p><p><strong>Conclusion: </strong>AMM levels before TIPS are independently associated with oHE after TIPS placement. AMM levels may serve as an additional marker for risk stratification of patients.</p><p><strong>Trial registration: </strong>Clinical trial number NCT04801290.</p>\",\"PeriodicalId\":23444,\"journal\":{\"name\":\"United European Gastroenterology Journal\",\"volume\":\" \",\"pages\":\"1171-1183\"},\"PeriodicalIF\":6.7000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463689/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"United European Gastroenterology Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/ueg2.70095\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"United European Gastroenterology Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ueg2.70095","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/9 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：放置经颈静脉肝内门静脉系统分流术（TIPS）是治疗门静脉高压症的有效方法。显性肝性脑病（oHE）是TIPS后的并发症，与发病率增加相关。与局部正常上限（ULN）相比，血浆氨（AMM）水平的升高与无TIPS的肝硬化患者的oHE、肝脏并发症和死亡率增加有关。AMM在tips后he风险分层中的作用尚不清楚。目的：探讨AMM在提示置入术患者oHE预测中的作用。方法：在一项前瞻性观察性研究方案中招募了放置TIPS的患者，并在TIPS后1、3、6和12个月进行随访（FU）。在TIPS放置后的第一年，对AMM水平与主要终点（oHE）和次要终点（肝失代偿、感染、死亡/肝移植）的关联进行事后分析。结果：188例接受TIPS治疗的患者中，有148例患者的AMM基线水平可用。在随访期间，37%（55/148）的患者发展为其他he。在多变量竞争风险分析中，基线AMM/ULN （HR 2.03 [CI 1.42-2.89], p = 0.001）和tips后生存（FIPS）评分Freiburg指数（HR 1.52 [CI 1.03-2.24], p = 0.037）与oHE独立相关。公布的截止AMM/ULN bbb1.4显示了类似的结果（HR 2.40 [CI 1.24-4.65], p = 0.01）。100例患者在FU1时出现AMM，其中28%（28/100）在FU1后发生了其他he。在多变量竞争风险分析中，AMM/ULN （HR 5.48 [CI 2.37-12.67], p）结论：TIPS植入前AMM水平与TIPS植入后的oHE独立相关。AMM水平可以作为患者风险分层的额外标志。试验注册：临床试验编号NCT04801290。
Background: Placement of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension. Overt hepatic encephalopathy (oHE) is a complication after TIPS associated with increased morbidity. Elevated ratio of plasma ammonia (AMM) levels compared to the local upper limit of normal (ULN) has been associated with oHE, hepatic complications and increased mortality in patients with cirrhosis without TIPS. The role of AMM in risk stratification of post-TIPS oHE is unclear.
Objective: To investigate the role of AMM in the prediction of oHE in patients receiving TIPS placement.
Methods: Patients with TIPS placement were recruited within a prospective observational study protocol with follow-up (FU) visits at 1, 3, 6, and 12 months after TIPS. Post hoc analyses of AMM levels for the association with the primary (oHE) and secondary endpoints (hepatic decompensation, infections, death/liver transplantation) during the first year after TIPS placement were performed.
Results: Of 188 patients with TIPS placement, 148 patients with available baseline AMM levels were included. During follow-up, 37% (55/148) of patients developed oHE. In multivariable competing risk analysis, baseline AMM/ULN (HR 2.03 [CI 1.42-2.89], p = 0.001) and Freiburg index of post-TIPS survival (FIPS) score (HR 1.52 [CI 1.03-2.24], p = 0.037) were independently associated with oHE. The published cut-off AMM/ULN > 1.4 showed comparable results (HR 2.40 [CI 1.24-4.65], p = 0.01). AMM at FU1 was available in 100 patients, of whom 28% (28/100) developed oHE after FU1. In multivariable competing risk analysis, AMM/ULN (HR 5.48 [CI 2.37-12.67], p < 0.001), psychometric hepatic encephalopathy score (HR 0.86 [0.78-0.96], p = 0.005) and FIPS (HR 3.57 [CI 1.79-7.14], p < 0.001) at FU1 were independently associated with oHE after FU1. No significant association between AMM/ULN and the secondary endpoints was detected.
Conclusion: AMM levels before TIPS are independently associated with oHE after TIPS placement. AMM levels may serve as an additional marker for risk stratification of patients.
Trial registration: Clinical trial number NCT04801290.
期刊介绍：
United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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