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2014 ; 3
(2
): 359-72
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Hyponatremia: A Risk Factor for Early Overt Encephalopathy after Transjugular
Intrahepatic Portosystemic Shunt Creation
#MMPMID26237379
Merola J
; Chaudhary N
; Qian M
; Jow A
; Barboza K
; Charles H
; Teperman L
; Sigal S
J Clin Med
2014[Apr]; 3
(2
): 359-72
PMID26237379
show ga
Hepatic encephalopathy (HE) is a frequent complication in cirrhotic patients
undergoing transjugular intrahepatic portosystemic shunt (TIPS). Hyponatremia
(HN) is a known contributing risk factor for the development of HE. Predictive
factors, especially the effect of HN, for the development of overt HE within one
week of TIPS placement were assessed. A single-center, retrospective chart review
of 71 patients with cirrhosis who underwent TIPS creation from 2006-2011 for
non-variceal bleeding indications was conducted. Baseline clinical and laboratory
characteristics were collected. Factors associated with overt HE within one week
were identified, and a multivariate model was constructed. Seventy one patients
who underwent 81 TIPS procedures were evaluated. Fifteen patients developed overt
HE within one week. Factors predictive of overt HE within one week included
pre-TIPS Na, total bilirubin and Model for End-stage Liver Disease (MELD)-Na. The
odds ratio for developing HE with pre-TIPS Na <135 mEq/L was 8.6. Among patients
with pre-TIPS Na <125 mEq/L, 125-129.9 mEq/L, 130-134.9 mEq/L and ?135 mEq/L, the
incidence of HE within one week was 37.5%, 25%, 25% and 3.4%, respectively. Lower
pre-TIPS Na, higher total bilirubin and higher MELD-Na values were associated
with the development of overt HE post-TIPS within one week. TIPS in hyponatremic
patients should be undertaken with caution.