title: Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension.
abstract: OBJECTIVE
  This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension.
  
  
  METHODS
  Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS.
  
  
  RESULTS
  The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: &gt;3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient.
  
  
  CONCLUSIONS
  The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS.
authors.affiliation: Department of Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Jiannan
authors.initials: J
authors.lastname: Yao
authors.affiliation: Department of Respiratory Medicine, NO. 731 Hospital of CASIC, Beijing 100074, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zuo
authors.affiliation: Department of Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Guangyu
authors.initials: G
authors.lastname: An
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Yue
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China. lfuquan@aliyun.com.
authors.forename: Fuquan
authors.initials: F
authors.lastname: Liu
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome