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Psychometric evaluation before TIPS predicts hepatic encephalopathy

Conducting a psychometric evaluation prior to the start of transjugular intrahepatic portosystemic shunt placement is useful for identifying which patients with cirrhosis will develop hepatic encephalopathy post-placement, according to published findings.

Researchers evaluated 82 consecutive patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt placement (TIPS) from January 2011 to December 2014 in a single center. All patients underwent the psychometric evaluation to identify those affected by covert hepatic encephalopathy (HE) before TIPS.

In the analyses, the incidence of the first episode of HE was measured, taking into account the nature of the competing risks in the data, according to the research.

Over the course of follow-up, 43% of patients developed overt HE (n = 35). Of these, 77% were found to have been affected by covert HE before TIPS, according to the psychometric evaluation.

The difference of post-TIPS HE was significant among patients with or without covert HE before TIPS (P = .0003).

Multivariate analysis showed age (sHR = 1.05; 95% CI, 1.02-1.08), Child-Pugh score (sHR = 1.29; 95% CI, 1.06-1.56) and covert HE (sHR = 3.16; 95% CI, 1.43-6.99) were independently associated with post-TIPS HE.

After considering data results of the psychometric evaluation, the negative predicting value was 0.8 for the entire cohort and 0.88 for the patients who underwent TIPS due to refractory ascites.

The researchers concluded: “Psychometric evaluation before TIPS is able to identify most of the patients who will develop HE after a TIPS and can be useful to select patients in order to have the lowest incidence of this important complication.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.