title: Clearing the Confusion over Hepatic Encephalopathy After TIPS Creation: Incidence, Prognostic Factors, and Clinical Outcomes.
abstract: OBJECTIVE
  To assess the incidence, prognostic factors, and clinical outcomes of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.
  
  
  METHODS
  In this single-institution retrospective study, 191 patients (m:f = 114:77, median age 54 years, median Model for End-Stage Liver Disease or MELD score 14) who underwent TIPS creation between 1999 and 2013 were studied. Medical record review was used to identify demographic characteristics, liver disease, procedure, and outcome data. Post-TIPS HE within 30 days was defined by new mental status changes and was graded according to the West Haven classification system. The influence of data parameters on HE occurrence and 90-day mortality was assessed using binary logistic regression.
  
  
  RESULTS
  TIPS was successfully created with hemodynamic success in 99 % of cases. Median final PSG was 7 mmHg. HE incidence within 30 days was 42 % (81/191; 22 % de novo, 12 % stable, and 8 % worsening). Degrees of HE included grade 1 (46 %), grade 2 (29 %), grade 3 (18 %), and grade 4 (7 %). Medical therapy typically addressed HE, and shunt reduction was necessary in only three cases. MELD score (P = 0.020) and age (P = 0.009) were significantly associated with HE development on multivariate analysis. Occurrence of de novo HE post-TIPS did not associate with 90-day mortality (P = 0.400), in contrast to worsening HE (P < 0.001).
  
  
  CONCLUSIONS
  The incidence of post-TIPS HE is non-trivial, but symptoms are typically mild and medically managed. HE rates are higher in older patients and those with worse liver function and should be contemplated when counseling on expected TIPS outcomes and post-procedure course.
authors.affiliation: University of Illinois College of Medicine, Chicago, IL, USA.
authors.forename: Leigh C
authors.initials: LC
authors.lastname: Casadaban
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
authors.forename: Jeet
authors.initials: J
authors.lastname: Minocha
authors.forename: Janesh
authors.initials: J
authors.lastname: Lakhoo
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Grant
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ray
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
mesh_terms: D002641:Chicago / Q000453:epidemiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors