Sarcopenia Is Risk Factor for Development of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement

Silvia Nardelli; Barbara Lattanzi; Sabrina Torrisi; Francesca Greco; Alessio Farcomeni; Stefania Gioia; Manuela Merli; Oliviero Riggio

doi:10.1016/j.cgh.2016.10.028

Sarcopenia Is Risk Factor for Development of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement

Clin Gastroenterol Hepatol. 2017 Jun;15(6):934-936. doi: 10.1016/j.cgh.2016.10.028. Epub 2016 Nov 2.

Authors

Silvia Nardelli¹, Barbara Lattanzi², Sabrina Torrisi², Francesca Greco², Alessio Farcomeni³, Stefania Gioia², Manuela Merli², Oliviero Riggio²

Affiliations

¹ Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy. Electronic address: nardelli.silvia@gmail.com.
² Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome, Italy.
³ Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.

PMID: 27816756
DOI: 10.1016/j.cgh.2016.10.028

Abstract

Background & aims: Hepatic encephalopathy (HE) is an important complication in patients with cirrhosis who received transjugular intrahepatic portosystemic shunts (TIPS). We investigated whether a decrease in muscle mass was associated independently with the occurrence of HE after TIPS.

Methods: We performed a prospective study of 46 consecutive patients with cirrhosis (mean age, 58.6 ± 9.1 y; mean model for end-stage liver disease score, 11.3 ± 3.3; mean Child-Pugh score, 7.6 ± 1.5) who received TIPS from January 2013 through December 2014 at a tertiary center in Rome, Italy. All patients underwent computed tomography analysis at the level of the third lumbar vertebrae to determine the skeletal muscle index; sarcopenia was defined by sex-specific cut-off values. We estimated the incidence of the first episode of HE after TIPS, taking into account the competing risk nature of the data (death or liver transplantation).

Results: Twenty-six patients (57%) were found to have sarcopenia. Twenty-one patients (46%) developed overt HE in the 7 ± 9 months after TIPS placement; all of these patients were sarcopenic, according to the skeletal muscle index. Of the 25 patients without HE after TIPS, only 5 had sarcopenia. In multivariate analysis, model for end-stage liver disease score (subdistribution hazard ratio, 1.16; 95% confidence interval, 1.01-1.34; P = .043) and sarcopenia (subdistribution hazard ratio, 31.3; 95% confidence interval, 4.5-218.07; P < .001) were associated independently with the development of HE after TIPS placement.

Conclusions: In a prospective study of 46 patients with cirrhosis, we found muscle wasting, probably owing to reduced processing of ammonia, to be associated with the development of HE after TIPS placement. Sarcopenia should be considered in selecting patients for TIPS therapy. Nutritional status should be evaluated in patients with sarcopenia before TIPS placement, which might reduce the incidence of HE.

Keywords: Hepatic Encephalopathy; Liver Fibrosis; MELD; Prognostic Factor; SMI; Sarcopenia; TIPS.

MeSH terms

Adult
Aged
Female
Hepatic Encephalopathy / epidemiology*
Humans
Italy / epidemiology
Liver Cirrhosis / complications*
Liver Cirrhosis / therapy*
Male
Middle Aged
Portasystemic Shunt, Surgical / adverse effects*
Prospective Studies
Risk Factors
Sarcopenia / complications*