High-mobility group protein B1: A predictive biomarker for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt.

Abstract

The aim of the present study was to investigate whether portal level of high-mobility group protein B1 (HMGB1) is associated with hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS). We enrolled 127 consecutive patients who underwent TIPS and collected portal and peripheral blood samples in our department from December 2017 to May 2019. HMGB1 levels were determined using enzyme-linked immunosorbent assay kits. HMGB1 and other HE related parameters were estimated by competing risk analysis, receiver operating characteristic (ROC) analysis and Kaplan-Meier analysis. Patients with HE after TIPS were older (P = .019) and had higher portal HMGB1 level (P = .038) than those without. Univariate competing risk analysis: age (sHR 1.025, P=.026), hepatorenal syndrome (sHR 3.149, P=.010), model for end-of-stage liver disease (MELD) score (sHR 1.055, P=.024), prior HE (sHR 4.029, P=.0005), portal HMGB1 before TIPS (sHR 1.177, P = .001) reached statistical significance. Multivariate analysis: age (sHR 1.025, P=.037), MELD score (sHR 1.062, P=.011), prior HE (sHR 2.492, P=.030) and portal HMGB1 level before TIPS (sHR 1.217, P=.0002) were significantly different. ROC analyses and Kaplan-Meier curve showed portal HMGB1 level changes before and after TIPS (ΔHMGB1) had good predictive value in the cut-off 0.012 ng/mL (AUC=0.748, P < .001, Sensitivity=0.743, Specificity=0.655). Portal HMGB1 may be a therapeutic target for post-TIPS HE.