title: Cognitive Impairment Predicts The Occurrence Of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt.
abstract: OBJECTIVE
  Hepatic encephalopathy (HE) is a major problem in patients treated with TIPS. The aim of the study was to establish whether pre-TIPS covert HE is an independent risk factor for the development of HE after TIPS.
  
  
  METHODS
  Eighty-two consecutive cirrhotic patients submitted to TIPS were included. All patients underwent the PHES to identify those affected by covert HE before a TIPS. The incidence of the first episode of HE was estimated, taking into account the nature of the competing risks in the data (death or liver transplantation).
  
  
  RESULTS
  Thirty-five (43%) patients developed overt HE. The difference of post-TIPS HE was highly significant (P=0.0003) among patients with or without covert HE before a TIPS. Seventy-seven percent of patients with post-TIPS HE were classified as affected by covert HE before TIPS. Age: (sHR 1.05, CI 1.02-1.08, P=0.002); Child-Pugh score: (sHR 1.29, CI 1.06-1.56, P=0.01); and covert HE: (sHR 3.16, CI: 1.43-6.99 P=0.004) were associated with post-TIPS HE. Taking into consideration only the results of PHES evaluation, the negative predicting value was 0.80 for all patients and 0.88 for the patients submitted to TIPS because of refractory ascites. Thus, a patient with refractory ascites, without covert HE before a TIPS, has almost 90% probability of being free of HE after TIPS.
  
  
  CONCLUSIONS
  Psychometric evaluation before TIPS is able to identify most of the patients who will develop HE after a TIPS and can be used to select patients in order to have the lowest incidence of this important complication.
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Nardelli
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Gioia
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pasquale
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pentassuglio
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.|Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.|Department of Radiology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Salvatori
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Leandra
authors.initials: L
authors.lastname: Nikolli
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Torrisi
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Greco
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Nicoletti
authors.affiliation: Policlinico Umberto I-Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
mesh_terms: D000328:Adult; D000368:Aged; D060825:Cognitive Dysfunction / Q000209:etiology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011594:Psychometrics; D012307:Risk Factors