Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review.
OBJECTIVE
Hepatic encephalopathy (HE) is a very common complication in patients after transjugular intrahepatic portosystemic shunt (TIPS). The purpose of this study is to determine the most robust predictors of post-TIPS HE by performing a systematic review of studies that identified the risk factors for patients with post-TIPS HE.


METHODS
A PUBMED search was performed using the predefined rule. Studies were selected for analysis based on certain inclusion and exclusion criteria. Data were extracted from each study on the basis of predefined items. Meta-analyses were executed to verify the relevant risk factors.


RESULTS
Thirty studies were included in this systematic review. In the 30 studies, the numbers of variables evaluated by univariate and multivariate analyses were 60 and 32, respectively. The numbers of variables found to be significant in univariate and multivariate analyses were 18 and 14, respectively. According to the accumulated number of studies that identified these variables as significant, the three most vigorous predictors of post-TIPS HE were age, prior HE and Child-Pugh class/score in both univariate analysis and multivariate analysis. Our meta-analysis showed that patients with HE before TIPS or higher Child-Pugh class/score had increased risk of post-TIPS HE.


CONCLUSIONS
Increased age, prior HE and higher Child-Pugh class/score were the most robust predictors for post-TIPS HE.
Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Ming
M
Bai
Xingshun
X
Qi
Zhiping
Z
Yang
Zhanxin
Z
Yin
Yongzhan
Y
Nie
Shanshan
S
Yuan
Kaichun
K
Wu
Guohong
G
Han
Daiming
D
Fan
D000367:Age Factors; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome