Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunts: Incidence and Risk Factors

Objectives: The aim of this study was to determine the incidence of new or worsened hepatic encephalopathy after transjugular intrahepatic portosystemic shunts (TIPS) and to ascertain which clinical characteristics are associated with this complication. Methods: At the University of California, San Francisco, over 22 months, TIPS were placed successfully in 108 adults. Seventy‐seven patients in whom it was possible to assess the development of encephalopathy comprised the study population. Clinically significant encephalopathy was assessed at protocol clinic follow‐up and, in some cases, by phone contact with the patient and the referring physician. Post‐TIPS encephalopathy was defined as new onset of clinical encephalopathy requiring treatment or worsening of preexisting encephalopathy within 1 yr of TIPS. Results: The overall incidence of new or worsened encephalopathy was 23% (18/77). Post‐TIPS encephalopathy was well controlled with lactulose in 78% of cases and was progressive in 22%. Multivariate analysis showed that an increased risk of encephalopathy was associated with an etiology of liver disease other than alcohol [relative risk (RR) 9.2, p= 0.0052], female gender (RR 3.0, p= 0.029), and hypoalbuminemia (RR 2.2 for each 1 g/dl decrease, p= 0.044). Conclusions: Hepatic encephalopathy is a common complication of TIPS that can be controlled medically in most patients. The identification of clinical variables associated with an increased risk of encephalopathy may be useful in the selection of appropriate candidates for this procedure.