Post-TIPS Overt Hepatic Encephalopathy Increases Long-Term but Not Short-Term Mortality in Cirrhotic Patients With Variceal Bleeding: A Large-Scale, Multicenter Real-World Study
This article relates to:
-
Editorial: Linking Overt Hepatic Encephalopathy Post-TIPS to Mortality!
- Volume 61Issue 7Alimentary Pharmacology & Therapeutics
- pages: 1238-1239
- First Published online: March 14, 2025
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Letter: Post-TIPS Hepatic Encephalopathy—The Long-Term Mortality Conundrum in Cirrhotic Patients With Portal Hypertension
- Volume 61Issue 11Alimentary Pharmacology & Therapeutics
- pages: 1830-1831
- First Published online: April 16, 2025
Yi Xiang
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Contribution: Data curation, Visualization, Writing - original draft
Search for more papers by this authorJun Tie
National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China
Contribution: Data curation, Validation, Investigation
Search for more papers by this authorGuangchuan Wang
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Formal analysis, Software
Search for more papers by this authorYuzheng Zhuge
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
Contribution: Writing - review & editing
Search for more papers by this authorHao Wu
Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
Contribution: Data curation, Validation
Search for more papers by this authorXiaoli Zhu
Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
Contribution: Methodology
Search for more papers by this authorHui Xue
Gastroenterology of the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
Contribution: Methodology
Search for more papers by this authorShanghao Liu
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Contribution: Validation, Formal analysis
Search for more papers by this authorLing Yang
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Contribution: Formal analysis, Visualization
Search for more papers by this authorJiao Xu
National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China
Contribution: Data curation
Search for more papers by this authorFeng Zhang
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
Contribution: Data curation
Search for more papers by this authorMingyan Zhang
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Methodology
Search for more papers by this authorBo Wei
Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
Contribution: Supervision
Search for more papers by this authorPeijie Li
Gastroenterology of the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
Contribution: Writing - review & editing
Search for more papers by this authorZe Wang
Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
Contribution: Methodology
Search for more papers by this authorWei Wu
Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
Contribution: Writing - review & editing
Search for more papers by this authorChao Chen
Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
Contribution: Formal analysis
Search for more papers by this authorShifeng Yang
Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Data curation
Search for more papers by this authorYicheng Han
Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Data curation
Search for more papers by this authorCorresponding Author
Chengwei Tang
Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
Correspondence:
Chunqing Zhang ([email protected]); Xiaolong Qi ([email protected]); Chengwei Tang ([email protected])
Contribution: Project administration, Conceptualization, Funding acquisition
Search for more papers by this authorCorresponding Author
Xiaolong Qi
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Correspondence:
Chunqing Zhang ([email protected]); Xiaolong Qi ([email protected]); Chengwei Tang ([email protected])
Contribution: Methodology, Funding acquisition, Project administration
Search for more papers by this authorCorresponding Author
Chunqing Zhang
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Correspondence:
Chunqing Zhang ([email protected]); Xiaolong Qi ([email protected]); Chengwei Tang ([email protected])
Contribution: Conceptualization, Methodology, Resources, Project administration, Supervision, Funding acquisition
Search for more papers by this authorYi Xiang
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Contribution: Data curation, Visualization, Writing - original draft
Search for more papers by this authorJun Tie
National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China
Contribution: Data curation, Validation, Investigation
Search for more papers by this authorGuangchuan Wang
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Formal analysis, Software
Search for more papers by this authorYuzheng Zhuge
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
Contribution: Writing - review & editing
Search for more papers by this authorHao Wu
Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
Contribution: Data curation, Validation
Search for more papers by this authorXiaoli Zhu
Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
Contribution: Methodology
Search for more papers by this authorHui Xue
Gastroenterology of the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
Contribution: Methodology
Search for more papers by this authorShanghao Liu
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Contribution: Validation, Formal analysis
Search for more papers by this authorLing Yang
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Contribution: Formal analysis, Visualization
Search for more papers by this authorJiao Xu
National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China
Contribution: Data curation
Search for more papers by this authorFeng Zhang
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
Contribution: Data curation
Search for more papers by this authorMingyan Zhang
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Methodology
Search for more papers by this authorBo Wei
Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
Contribution: Supervision
Search for more papers by this authorPeijie Li
Gastroenterology of the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
Contribution: Writing - review & editing
Search for more papers by this authorZe Wang
Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
Contribution: Methodology
Search for more papers by this authorWei Wu
Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
Contribution: Writing - review & editing
Search for more papers by this authorChao Chen
Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
Contribution: Formal analysis
Search for more papers by this authorShifeng Yang
Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Data curation
Search for more papers by this authorYicheng Han
Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Contribution: Data curation
Search for more papers by this authorCorresponding Author
Chengwei Tang
Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
Correspondence:
Chunqing Zhang ([email protected]); Xiaolong Qi ([email protected]); Chengwei Tang ([email protected])
Contribution: Project administration, Conceptualization, Funding acquisition
Search for more papers by this authorCorresponding Author
Xiaolong Qi
Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging and Interventional Radiology, Nanjing, Jiangsu, China
Correspondence:
Chunqing Zhang ([email protected]); Xiaolong Qi ([email protected]); Chengwei Tang ([email protected])
Contribution: Methodology, Funding acquisition, Project administration
Search for more papers by this authorCorresponding Author
Chunqing Zhang
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
Correspondence:
Chunqing Zhang ([email protected]); Xiaolong Qi ([email protected]); Chengwei Tang ([email protected])
Contribution: Conceptualization, Methodology, Resources, Project administration, Supervision, Funding acquisition
Search for more papers by this authorFunding: This work was supported by Jiangsu Provincial Key Research and Development Program, BE2023767, National Key Research and Development Program of China, 2023YFC2507500.
Yi Xiang, Jun Tie and Guangchuan Wang contributed equally to this work.
ABSTRACT
Background
Transjugular intrahepatic portosystemic shunt (TIPS) is an established procedure for managing portal hypertension in cirrhotic patients, but the impact of post-TIPS overt hepatic encephalopathy (OHE) on survival remains controversial. While its effect on short-term survival is well-documented, its long-term implications remain unclear.
Aims
This study aims to investigate the long-term impact of post-TIPS OHE on mortality in cirrhotic patients for variceal bleeding, focusing on the timing and predictive value of OHE beyond the first year post-TIPS.
Methods
A multicenter, retrospective cohort study was conducted involving 3262 cirrhotic patients who underwent TIPS for variceal bleeding at seven Chinese tertiary centers between January 2010 and June 2020. Clinical data, including demographics, procedure details, post-TIPS complications and survival outcomes, were collected. The primary endpoints were all-cause mortality and OHE, with follow-up until death, liver transplantation or 60 months. Propensity score matching minimised confounding effects, and multivariate Fine-Grey competing risk models identified independent mortality predictors.
Results
During a median follow-up of 1077 days, 33.2% developed post-TIPS OHE, associated with higher MELD and Child-Pugh scores. Among these, 19.3% died, with a median time from OHE onset to death of 947 days. Post-TIPS OHE was not linked to early survival (within 12 months) but emerged as an independent predictor of long-term mortality beyond 24 months, consistent across various clinical scenarios.
Conclusion
Post-TIPS OHE does not affect short-term survival but significantly increases long-term mortality risk. These findings highlight the need for continuous monitoring and tailored interventions to improve long-term outcomes in post-TIPS patients.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The source codes and the complete dataset included in the study are available from the corresponding authors upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| apt18509-sup-0001-Supinfo.docxWord 2007 document , 320 KB |
Data S1: |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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