Table 3.
Univariable and multivariable competing risk analysis for the development of overt HE in the first 180 days after TIPS insertion.
| Evaluated factors | Hazard ratio | Lower 95% CI | Upper 95% CI | p value |
|---|---|---|---|---|
| Univariable competing risk analysis (n = 84) | ||||
| Age | 1.051 | 1.005 | 1.099 | 0.028 |
| Sex male | 0.5408 | 0.2488 | 1.175 | 0.12 |
| Stent diameter 6 mm | 0.7026 | 0.304 | 1.624 | 0.41 |
| Aetiology of cirrhosis | ||||
| Alcohol related | 0.4878 | 0.2221 | 1.071 | 0.074 |
| NASH | 0.8384 | 0.227 | 1.795 | 0.39 |
| Viral | 0.5939 | 0.08178 | 4.313 | 0.61 |
| TIPS indication (multiple selection possible) | ||||
| Refractory ascites | 1.212 | 0.4414 | 3.326 | 0.71 |
| Bleeding | 1.023 | 0.438 | 2.39 | 0.96 |
| PSG before TIPS (mmHg) | 1.005 | 0.9156 | 1.103 | 0.91 |
| PSG after TIPS (mmHg) | 0.9805 | 0.8482 | 1.133 | 0.79 |
| Diabetes at baseline | 2.151 | 0.9971 | 4.639 | 0.051 |
| History of HE | 1.879 | 0.8208 | 4.303 | 0.14 |
| PHES | 0.9866 | 0.8952 | 1.087 | 0.79 |
| PHES pathological | 1.458 | 0.5936 | 3.581 | 0.41 |
| CFF (Hz) | 0.9406 | 0.8812 | 1.004 | 0.066 |
| CFF pathological | 1.852 | 0.8014 | 4.279 | 0.15 |
| ANT (animals per minute) | 0.9871 | 0.9402 | 1.036 | 0.6 |
| ANT pathological | 1.41 | 0.6206 | 3.204 | 0.41 |
| Number of pathological mHE tests at baseline | 1.264 | 0.8603 | 1.859 | 0.23 |
| Sodium (mmol/L) | 1.016 | 0.9447 | 1.093 | 0.67 |
| Creatinine (μmol/L) | 1.004 | 0.9964 | 1.013 | 0.28 |
| CHE (kU/L) | 1.097 | 0.8512 | 1.415 | 0.47 |
| Bilirubin (μmol/L) | 0.9907 | 0.9667 | 1.015 | 0.46 |
| Albumin (g/L) | 0.9549 | 0.8999 | 1.013 | 0.13 |
| Haemoglobin (g/dl) | 1.044 | 0.8793 | 1.239 | 0.62 |
| Platelets (tsd/μl) | 0.9979 | 0.9933 | 1.002 | 0.35 |
| INR | 0.08604 | 0.0038 | 1.944 | 0.12 |
| Ammonia (μmol/L) | 1.007 | 0.9782 | 1.037 | 0.63 |
| MELD | 0.9682 | 0.8503 | 1.102 | 0.63 |
| FIPS score | 1.362 | 0.8291 | 2.237 | 0.22 |
| Child–Pugh score | 1.149 | 0.8478 | 1.558 | 0.37 |
| HE prophylaxis at discharge | ||||
| Lactulose∗ | 0.4251 | 0.162 | 1.116 | 0.082 |
| Rifaximin† | 0.6838 | 0.3155 | 1.482 | 0.34 |
| l-Ornithine l-aspartate‡ |
0.3 |
0.0778 |
1.157 |
0.08 |
| Multivariable competing risk analysis | ||||
| Model 1§ | ||||
| PHES | 0.9982 | 0.9006 | 1.106 | 0.970 |
| CFF | 0.9536 | 0.8918 | 1.020 | 0.160 |
| ANT | 1.00 | 0.9506 | 1.052 | 0.99 |
| PHES |
0.9982 |
0.9006 |
1.106 |
0.970 |
| Model 2¶ | ||||
| PHES | 0.9914 | 0.8887 | 1.106 | 0.88 |
| CFF | 0.9420 | 0.8782 | 1.010 | 0.095 |
| ANT | 0.9836 | 0.9265 | 1.044 | 0.59 |
| PHES | 0.9914 | 0.8887 | 1.106 | 0.88 |
Time-dependent Fine–Gray model for competing risk analysis treating death or liver transplantation as competitor. Values of p <0.05 are highlighted in bold font.
ANT, animal naming test; CFF, critical flicker frequency; CHE, cholinesterase; FIPS, Freiburg index of post-TIPS survival; HE, hepatic encephalopathy; INR, international normalised ratio; MELD, model for end-stage liver disease; mHE, minimal hepatic encephalopathy; NASH, non-alcoholic steatohepatitis; PHES, psychometric hepatic encephalopathy score; PSG, portosystemic gradient; TIPS, transjugular intrahepatic portosystemic shunt.
Dose: up-titrating dose until two to three bowel movements per day.
Dose: 1,100 mg/day.
Dose: 9–18 g/day.
With all factors with p <0.05 in univariable analysis: age.
With preselected factors: rifaximin, FIPS, stent diameter.