Risk factors of hepatic myelopathy after transjugular intrahepatic portosystem stent-shunt

Abstract

Objective To investigate risk factors of hepatic myelopathy (HM) after transjugular intrahepatic portosystem stent-shunt (TIPS), and to explore the correlation between HM after TIPS and long term survival. Methods From January 2005 to September 2014, patients with liver cirrhosis received TIPS treatment because of complications associated with portal hypertention were collected. After operation, all patients were followed up by telephone at one, three, six months and later every six months, and the follow-up stopped until death or September 2015. Univariate and multivariate Logistic regression analysis was performed to screen risk factors of HM, and the survival of patients was compared and analyzed. Results A total of 1 101 patients with liver cirrhosis and successfully treated by TIPS were enrolled, and they were divided into HM group (n=80) and non-HM group (n=1 021). The median follow-up time was 44.77 months (range, 2.87-129.80 months). Male (hazard ratio (HR)=2.825, 95%CI:1.454-5.179), splenectomy history (HR=1.829, 95%CI:1.024-3.265) and post-TIPS hepatic encephalopathy (HE) (HR=5.057, 95%CI:2.824-9.055) were risk factors of HM by multivariate Logistic regression analysis (all P<0.05). The median survival time of HM group and non-HM group was 69.93 and 58.43 months, respectively. There was no statistically significant difference in survival time between two groups (P=0.208). The one, three and five years cumulative survival rates of the above two groups were 96.25%, 73.28%, 61.13% and 81.36%, 64.28%, 49.11%, respectively. Conclusion The risk of HM after TIPS is increased in male liver cirrhosis patients with splenectomy. To reduce the risk of HM, a positive prevention of HE after TIPS is recommended. Key words: Portasystemic shunt, transjugular intrahepatic; Hepatic encephalopathy; Spinal cord diseases; Risk factor