Does Early Post-TIPS Hepatic Encephalopathy Affect Survival?

TOPLINE: 

Early hepatic encephalopathy following transjugular intrahepatic portosystemic shunt (TIPS) insertion, especially within the first 30 days, was associated with reduced survival in patients with liver cirrhosis. The presence of pre-procedure encephalopathy further increased this risk, particularly when combined with early post-procedure episodes.

METHODOLOGY:

• Researchers conducted a retrospective study to investigate the impact of post-TIPS hepatic encephalopathy and its timing on the survival of patients.
• They included 1356 patients (median age, 59 years; 64% men) who were diagnosed with liver cirrhosis and underwent TIPS insertion for refractory or recurrent ascites or recurrent bleeding at eight German centres between 2004 and 2021.
• All patients received polytetrafluoroethylene-covered stents with diameters ranging from 6 to 10 mm.
• Patients were followed for up to 30 months after TIPS insertion for the occurrence of hepatic encephalopathy, which was classified as grade 2-4 according to the West-Haven criteria and International Society for Hepatic Encephalopathy and Nitrogen Metabolism guidelines.
• The impact of post-TIPS hepatic encephalopathy on survival was assessed using a competing risk analysis, with liver transplantation as the competing event and death as the event of interest. The assessment was performed at the landmark times of 30 and 90 days after TIPS insertion.

TAKEAWAY:

• Overall, 27.8% of patients experienced hepatic encephalopathy after TIPS insertion, and those who did had worse survival than those who did not (subdistribution hazard ratio [sHR], 1.41; P < .001).
• Compared with no hepatic encephalopathy, early hepatic encephalopathy within 30 days of TIPS insertion was associated with significantly worse survival (sHR, 2.02; P < .001); this association persisted in multivariable analyses.
• Additionally, patients who developed hepatic encephalopathy within 90 days of TIPS insertion had a worse prognosis than those who did not (sHR, 1.73; P = .009), with findings consistent in multivariable analyses.
• Both pre-TIPS hepatic encephalopathy and its combination with early post-TIPS hepatic encephalopathy were associated with impaired survival (both P < .001).

IN PRACTICE:

“Post-TIPS HE [hepatic encephalopathy] may reflect the patients’ overall vulnerability leading to an increased risk for complications and thus explaining the overall poorer prognosis of these patients,” the authors wrote. 

SOURCE:

This study was led by Martin A. Kabelitz, Hannover Medical School, Hannover, Germany, and was published online on March 15, 2025, in Clinical Gastroenterology and Hepatology.

LIMITATIONS: 

The retrospective design of this study may have introduced bias, and the lack of structured follow-up may have resulted in missed episodes of hepatic encephalopathy. Information on patients referred for transplantation was unavailable. Differences between centres may have existed in terms of disease severity, inclusion periods, or medication use.

DISCLOSURES:

This study was partly supported by the German Center for Infectious Research, and the leading author was supported by the KlinStrucMed programme at Hannover Medical School. Several other authors reported receiving lecture, consulting, or personal fees; receiving research or travel support; or serving as consultants, advisors, or speakers bureau members for various pharmaceutical, diagnostic, and healthcare companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.