title: Pre-transjugular intrahepatic portosystemic shunts (TIPS) prediction of post-TIPS overt hepatic encephalopathy: the critical flicker frequency is more accurate than psychometric tests.
abstract: Transjugular intrahepatic portosystemic shunts (TIPS) is a second-line treatment because of an increased incidence of overt hepatic encephalopathy (OHE). A better selection of patients to decrease this risk is needed and one promising approach could be the detection of minimal hepatic encephalopathy (MHE). The aim of the present prospective study was to determine whether pre-TIPS minimal hepatic encephalopathy was predictive of post-TIPS OHE and to compare Psychometric Hepatic Encephalopathy Sum Score(PHES) and the Critical Flicker Frequency (CFF) in this setting. From May 2008 to January 2011, 54 consecutive patients treated with TIPS were included. PHES and CFF were performed 1 to 7 days before and after TIPS at months 1, 3, 6, 9, and 12 or until liver transplantation or death. Before TIPS, MHE was detected by PHES and CFF in 33% and 39% of patients, respectively. After the TIPS procedure, 19 patients (35%) experienced a total of 64 episodes of OHE. OHE developed significantly more often inpatients for whom an indication for TIPS had been refractory ascites, with a history of OHE or of renal failure, lower hemoglobin level, or MHE as diagnosed by CFF. Post-TIPS OHE was more accurately predicted by CFF than by PHES. Absence of MHE at CFF had a good negative predictive value (91%) for the risk of post-TIPS recurrent OHE, defined as the occurrence of three or more episodes of OHE or of one episode which lasted more than 15 days. The absence of pre-TIPS history of OHE and a CFF value equal to or greater than 39 Hz had a 100% negative predictive value for post-TIPS recurrent OHE.
  
  
  CONCLUSIONS
  Aiming to decrease the rate of post-TIPS HE, the use of CFF could help selecting patients for TIPS.
authors.forename: Pierre
authors.initials: P
authors.lastname: Berlioux
authors.forename: Marie Angèle
authors.initials: MA
authors.lastname: Robic
authors.forename: Hélèe
authors.initials: H
authors.lastname: Poirson
authors.forename: Sophie
authors.initials: S
authors.lastname: Métivier
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Carine
authors.initials: C
authors.lastname: Barret
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lopez
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Péron
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Vinel
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
mesh_terms: D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D015994:Incidence; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods*; D012307:Risk Factors