History of Hepatic Encephalopathy is Not a Contraindication to TIPS Placement for Refractory Ascites

Background: The outcomes of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with hepatic encephalopathy (HE) is controversial. We studied the relationship of pre-TIPS HE in patients undergoing TIPS for refractory ascites on all-cause mortality and development of post-TIPS HE. Methods: A single-center retrospective, comparison study was performed for patients undergoing TIPS for refractory ascites. Survival by history of pre-TIPS HE was demonstrated with Kaplan-Meier curves. Univariate and multivariate logistic regression analyses were performed to identify the predictors of post-TIPS clinical outcomes for patients with and without pre-TIPS HE. Findings: We identified 202 TIPS recipients (61% male, mean ±SD; age 59.1 ±10.2 years; mean Model for End-Stage Liver Disease (MELD) score 17.3 ±6.9). Pre-TIPS HE did not predispose patients for increased all-cause mortality, increased risk of developing HE within 60 days, or increased risk of hospital admission for HE within 6 months. A multivariate analysis demonstrated that total bilirubin (Odds Ratio [OR] 1.04; p=0.007), and blood urea nitrogen (OR 1.16; p =0.001) were predictors for all-cause mortality within 6 months post-TIPS. Age ≥65 (OR 3.92; p=0.004), creatinine (OR, 2.22; p=0.014), and Child Pugh score (OR 1.53; p=0.006) were predictors for HE within 60 days post-TIPS. Predictors of intensive care admission for HE within 6 months post-TIPS included age ≥65 (OR 8.84; p=0.018), history of any admission for HE within 6 months pre-TIPS (OR 8.42; p=0.017), and creatinine (OR 2.22; p=0.015). Interpretation: Pre-TIPS HE does not adversely impact patient survival or clinical outcomes, such as development of HE within 60 days of TIPS or hospital admission for HE within 6 months. Patients may be able to undergo TIPS for refractory ascites despite a history of HE. Funding Statement: This study received support for data storage infrastructure from the UCLA Clinical and Translational Science Institute (CTSI Grant UL1TR001881). Declaration of Interests: All authors have no conflicts of interest. Ethics Approval Statement: The institutional review board approved this single-center retrospective study (IRB#10-000464)