Observational Cohort Study of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Routhu, Michaela; Šafka, Václav; Routhu, Sunil Kumar; Fejfar, Tomáš; Jirkovský, Václav; Krajina, Antonı́n; Čermáková, Eva; Hůlek, P; Hosák, Ladislav

doi:10.5604/16652681.1226932

Cited by 28 publications

(26 citation statements)

References 28 publications

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“…Liver tests were performed at the time of inclusion after fasting for a minimum of 3 h. The procedure is based on body weightadjusted (2 mg/kg) intravenous 13 C-labeled methacetin bolus injection and subsequent injection of 20 mL 0.9% sodium chloride as described [21]. Exhaled breath is collected by a distinct two-way face mask and analyzed by means of a special device (Humedics, Berlin, Germany).…”

Section: Limax Testmentioning

confidence: 99%

“…Herein, we are able to achieve a continuous real-time sampling rate and optimal analysis of delta-over-baseline (DOB) curves of 13 CO 2 / 12 CO 2 ratios. 13 C-methacetin is a substrate of the hepatic CYP1A2 enzyme, which exclusively metabolizes it into paracetamol and 13 CO 2 [26]. Prior to substrate injection, the baseline 13 CO 2 / 12 CO 2 ratio is recorded in the native expired air to calculate the individual baseline.…”

Section: Limax Testmentioning

confidence: 99%

“…Acute hepatic decompensation after TIPSS placement is less common, but represents a life-threatening clinical challenge [2,11]. Parameters applied to stratify patients at risk for HE and LFAC after TIPSS placement include age, serum bilirubin concentrations, model for end-stage liver disease (MELD) score, and Child-Pugh grade [7,12,13]. Although these parameters are widely available, HE and other LFAC post TIPSS implantation still occur; therefore, additional predictive markers are warranted [2,13].…”

Section: Introductionmentioning

confidence: 99%

“…Parameters applied to stratify patients at risk for HE and LFAC after TIPSS placement include age, serum bilirubin concentrations, model for end-stage liver disease (MELD) score, and Child-Pugh grade [7,12,13]. Although these parameters are widely available, HE and other LFAC post TIPSS implantation still occur; therefore, additional predictive markers are warranted [2,13]. Current markers are hampered by the insensitivity to detect subtle alterations of liver function due to the large functional reserve of the liver.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, the maximum liver function capacity (Li-MAx) test was proposed as a new 13 C-methacetin-based QLFT for the assessment of liver function as well as functional hepatic reserve. The procedure is based on body weight-adjusted intravenous 13 C-labeled methacetin injection and its subsequent specific metabolization by the enzyme CYP1A2 into paracetamol and 13 CO 2 . The higher the degree of liver insufficiency, the less 13 C-methacetin is metabolized and the less 13 CO 2 is produced, resulting in decreased LiMAx levels.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Power of Liver Maximum Function Capacity Test in Transjugular Intrahepatic Portosystemic Shunt Patients: A Pilot Study

Reichert

Schulz

Maßmann

et al. 2019

Dig Dis

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Background: Transjugular intrahepatic shunt (TIPSS) is placed in patients with variceal bleeding, refractory ascites, and for other indications. Postprocedural liver function-associated complications (LFAC), including hepatic encephalopathy (HE) and liver failure, represent a major setback. Current methods to predict complications are insufficient. Objectives: We investigated in a pilot study of patients prior TIPSS placement whether the risk of LFAC correlates with the functional reserve of the liver, as assessed by liver maximum function capacity (LiMAx) test. Methods: Prospectively we included patients prior TIPSS placement between June 2016 and November 2017 at Saarland University Medical Center. LiMAx was conducted before and after TIPSS placement. Patients with HE prior TIPSS, as well as other factors predisposing to HE, including concomitant sedative drugs, current bacterial infections and sepsis, were excluded. Overt HE (OHE), LiMAx, and laboratory values were assessed before and after TIPSS placement. Data were analyzed in multivari-ate regression and AUROC models. Results: Mean age was 60 ± 8 years. Patients (n = 20) were mainly men (65%), and presented predominantly with Child-Pugh class B (90%). Indications for TIPSS were most commonly refractory ascites or recurrent variceal bleeding. In total, 40% of the patients developed LFAC after TIPSS placement. Expectedly, LiMAx decreased and serum bilirubin increased after TIPSS. LiMAx drop ≥20% was the only parameter predicting the development of LFAC after TIPSS in multivariate regression and AU-ROC analysis. Conclusions: In multivariate regression models and AUROC analysis, a drop in LiMAx predicted the development of LFAC after TIPSS placement. Additional larger studies assessing OHE and early liver failure separately are warranted.

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Section: Limax Testmentioning

confidence: 99%

Section: Limax Testmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive Power of Liver Maximum Function Capacity Test in Transjugular Intrahepatic Portosystemic Shunt Patients: A Pilot Study

Reichert

Schulz

Maßmann

et al. 2019

Dig Dis

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Case–control study: Proton pump inhibitor use is a major risk factor for hepatic encephalopathy after TIPS

2021

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Summary Background In cirrhotic patients, hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (post‐TIPS HE) is common. Measures that reduce the severity of post‐TIPS HE are limited. Though recent data suggest an association between PPI use and HE, the risk in post‐TIPS HE is not well understood. Aims Examine the risk of post‐TIPS HE associated with differing classes of medications, including proton pump inhibitors (PPI). Methods Between 2012 and 2019, we collected data on known risk factors for post‐TIPS HE as well as medications used. Subjects were classified according to the development of overt hepatic encephalopathy requiring admission. Results In our cohort, admission after TIPS was common, with an average of 7.84 admissions in the post‐TIPS HE group versus 3.76 in the no HE group (P = 0.028). Consistent with previous studies, we found that MELD, grade of encephalopathy, and lower portosystemic gradient were associated with the development of post‐TIPS HE. PPI use prior to TIPS was highly associated with post‐TIPS HE (RR: 4.89, 95% CI: 1.91‐12.50). The risk of post‐TIPS HE was highest 1‐4 weeks post‐procedure but persisted for up to one year after TIPS. Other classes of acid‐suppressive medications, such as histamine receptor blockers (RR: 0.357, 0.154‐0.824) and sucralfate (RR: 0.123, 0.016‐0.924) did not demonstrate this association. Conclusions PPI use is a strong risk factor for the development of post‐TIPS HE. Clinicians should consider the risks and benefits of PPIs in cirrhotic patients undergoing TIPS. Further studies are needed to demonstrate the benefit of discontinuation of PPI, or switching to alternatives.

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Efficacy and safety of transjugular intrahepatic portosystemic shunt combined with transcatheter embolization/chemoembolization in hepatocellular carcinoma with portal hypertension and arterioportal shunt

Xuan

Luo

et al. 2021

Abdom Radiol

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Observational Cohort Study of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Abstract: we have identified, using a substantial sample, several factors associated with the development of HE after TIPS. This could be helpful in further research.

Cited by 28 publications

References 28 publications

Predictive Power of Liver Maximum Function Capacity Test in Transjugular Intrahepatic Portosystemic Shunt Patients: A Pilot Study

Predictive Power of Liver Maximum Function Capacity Test in Transjugular Intrahepatic Portosystemic Shunt Patients: A Pilot Study

Case–control study: Proton pump inhibitor use is a major risk factor for hepatic encephalopathy after TIPS

Efficacy and safety of transjugular intrahepatic portosystemic shunt combined with transcatheter embolization/chemoembolization in hepatocellular carcinoma with portal hypertension and arterioportal shunt

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