Clinical value of hemodynamic changes in diagnosis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Abstract

Objective

This paper aims to investigate clinical value of intrahepatic and intra-stent hemodynamic changes after transjugular intrahepatic portosystemic shunt (TIPS), by using color Doppler ultrasound during the diagnosis of hepatic encephalopathy (HE) in the patients with hepatitis B cirrhosis.

Methods

A retrospective analysis of the patients with hepatitis B cirrhotic portal hypertension, who underwent TIPS in The First Affiliated Hospital of Anhui Medical University from January 2018 to January 2021, was conducted. 22 patients who developed HE within 3 months after TIPS comprised the observation group (HE group), and 51 patients who did not develop HE were randomly selected as the control group (non-HE group). The porto systemic gradient (PSG), as well as intrahepatic and intra-stent hemodynamic changes of patients in both the HE group and the non-HE group after TIPS were investigated.

Results

The intra-stent blood flow, PSG difference, and PSG decrease percentage in the HE group were higher than those in the non-HE group, and the intra-stent flow had a weak positive correlation with PSG difference and with the PSG decrease percentage (r = 0.420, 0.258, respectively). The areas under the ROC curves of HE based on the PSG difference, the PSG decrease percentage, and the intra-stent flow were 0.762, 0.753, and 0.693, respectively.

Conclusion

The more obvious decrease in PSG, the larger the intra-stent blood flow, and the larger the possibility of HE occurrence were observed. Routine ultrasound measurement of hemodynamic changes has certain clinical significance for predicting HE occurrence.

Keywords:

• Transjugular intrahepatic portosystemic shunt (TIPS)
• hepatic encephalopathy (HE)
• Doppler ultrasound
• hemodynamic changes
• porto systemic gradients (PSG)

Acknowledgments

The authors thank all patients and colleagues for their participation in this study.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This study was supported by the Department of Science and Technology of Anhui Province, Hefei, China, through the Key Research and Development Program of Anhui Province under grant [202004j07020031].