The characteristics and risk factors of hepatic encephalopathy after emergent TIPS operation in patients with bleeding from esophageal and gastric varices

Abstract

Abstract: Objective To investigate the characteristics and risk factors of hepatic encephalopathy after emergent transjugular intrahepatic portosystemic shunt (TIPS) operation in patients with bleeding from esophageal and gastric varices (EGV).Methods The clinical data of 102 patients with liver cirrhosis accompanied by rupture of EGV who were admitted to the Third People’s Hospital of Zigong City from July 2015 to July 2020 and treated with TIPS within 72h were retrospectively analyzed. The patients were followed-up for 6 months. They were divided into 42 cases of hepatic encephalopathy (HE) group and 60 cases of non-hepatic encephalopathy (non-HE) group according to whether they occurred HE after operation. The baseline data and biochemical indicators of patients before TIPS surgery were collected and compared, followed by univariate and multivariate Logistic regression analysis for the risk factors of HE after TIPS.Results There were a total of 102 subjects enrolled in this study. Within them, 42 occurred HE, with 20 cases (47.62%) of grade 0~1, 11 cases of grade 2 (26.19%), 7 cases of grade 3 (16.675), and 5 cases of grade 4 (11.90%). The Results of univariate analysis showed that coagulation time, MELD score and HVPG in patients with EGV hemorrhage were associated with HE after TIPS (P<0.05). Multivariate logistic regression analysis showed that MELD score (OR=3.50, 95%CI: 1.70～7.10), HVPG (OR=3.90, 95%CI: 1.58～9.67) were independent risk factors for HE after TIPS operation in patients with ruptured EGV (P<0.05).Conclusion The incidence of HE after emergency TIPS is higher in patients with EGV bleeding. Among them, MELD score and HVPG are independent risk factors for HE after TIPS. Therefore, preoperative MELD score and HVPG can predict the risk of postoperative HE.

Key words: Esophageal and gastric varices, Rupture and bleeding, Transjugular intrahepatic portosystemic shunt, Hepatic encephalopathy, Risk factors

LIU Yi, ZHOU Zi-zhong, LIU Gang, XU Hai-rong. The characteristics and risk factors of hepatic encephalopathy after emergent TIPS operation in patients with bleeding from esophageal and gastric varices[J]. Chinese Hepatolgy, 2022, 27(6): 658-661.

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