No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt.
Hepatic encephalopathy (HE) is a major problem in patients submitted to TIPS. Previous studies identified low albumin as a factor associated to post-TIPS HE. In cirrhotics with diuretic-induced HE and hypovolemia, albumin infusion reduced plasma ammonia and improved HE. Our aim was to evaluate if the incidence of overt HE (grade II or more according to WH) and the modifications of venous blood ammonia and psychometric tests during the first month after TIPS can be prevented by albumin infusion. Twenty-three patients consecutively submitted to TIPS were enrolled and treated with 1 g/Kg BW of albumin for the first 2 days after TIPS followed by 0,5 g/Kg BW at day 4th and 7th and then once a week for 3 weeks. Forty-five patients included in a previous RCT (Riggio et al. 2010) followed with the same protocol and submitted to no pharmacological treatment for the prevention of HE, were used as historical controls. No differences in the incidence of overt HE were observed between the group of patients treated with albumin and historical controls during the first month (34 vs 31 %) or during the follow-up (39 vs 48 %). Two patients in the albumin group and three in historical controls needed the reduction of the stent diameter for persistent HE. Venous blood ammonia levels and psychometric tests were also similarly modified in the two groups. Survival was also similar. Albumin infusion has not a role in the prevention of post-TIPS HE.
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy. oliviero.riggio@uniroma1.it.|Centro di Riferimento per l'Ipertensione Portale, II Gastroenterologia, Dipartimento di Medicina Clinica, "Sapienza" Università di Roma, Viale dell'Università 37, 00185, Roma, Italy. oliviero.riggio@uniroma1.it.
Oliviero
O
Riggio
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Silvia
S
Nardelli
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Chiara
C
Pasquale
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Ilaria
I
Pentassuglio
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Stefania
S
Gioia
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Eugenia
E
Onori
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Camilla
C
Frieri
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Filippo Maria
FM
Salvatori
Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension "Sapienza" University of Rome, Rome, Italy.
Manuela
M
Merli
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000639:trends; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D000075462:Serum Albumin, Human / Q000008:administration & dosage*; D016896:Treatment Outcome
D000075462:Serum Albumin, Human
Albumin; Hepatic encephalopathy; Liver cirrhosis; TIPS