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Hepatic-associated vascular morphological assessment to predict overt hepatic encephalopathy before TIPS: a multicenter study.
- Source :
- Hepatology International; Aug2024, Vol. 18 Issue 4, p1238-1248, 11p
- Publication Year :
- 2024
-
Abstract
- Background: To provide patients the chance of accepting curative transjugular intrahepatic portosystemic shunt (TIPS) rather than palliative treatments for portal hypertension-related variceal bleeding and ascites, we aimed to assess hepatic-associated vascular morphological change to improve the predictive accuracy of overt hepatic encephalopathy (HE) risks. Methods: In this multicenter study, 621 patients undergoing TIPS were subdivided into training (413 cases from 3 hospitals) and external validation datasets (208 cases from another 3 hospitals). In addition to traditional clinical factors, we assessed hepatic-associated vascular morphological changes using maximum diameter (including absolute and ratio values). Three predictive models (clinical, hepatic-associated vascular, and combined) were constructed using logistic regression. Their discrimination and calibration were compared to test the necessity of hepatic-associated vascular assessment and identify the optimal model. Furthermore, to verify the improved performance of Model<superscript>C−V</superscript>, we compared it with four previous models, both in discrimination and calibration. Results: The combined model outperformed the clinical and hepatic-associated vascular models (training: 0.814, 0.754, 0.727; validation: 0.781, 0.679, 0.776; p < 0.050) and had the best calibration. Compared to previous models, Model<superscript>C−V</superscript> showed superior performance in discrimination. The high-, middle-, and low-risk populations displayed significantly different overt HE incidence (p < 0.001). Despite the limited ability of pre-TIPS ammonia to predict overt HE risks, the combined model displayed a satisfactory ability to predict overt HE risks, both in the low- and high-ammonia subgroups. Conclusion: Hepatic-associated vascular assessment improved the predictive accuracy of overt HE, ensuring curative chances by TIPS for suitable patients and providing insights for cirrhosis-related studies. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 19360533
- Volume :
- 18
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Hepatology International
- Publication Type :
- Academic Journal
- Accession number :
- 178835310
- Full Text :
- https://doi.org/10.1007/s12072-024-10686-2