Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 27;16(7):2054-2064.
doi: 10.4240/wjgs.v16.i7.2054.

Spleen volume is associated with overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with portal hypertension

Chun-Juan Zhao  1   2 , Chao Ren  1 , Zhen Yuan  3 , Guo-Hui Bai  1 , Jin-Yu Li  4   5 , Long Gao  4   5 , Jin-Hui Li  1 , Ze-Qi Duan  6 , Dui-Ping Feng  4   5 , Hui Zhang  1   2   7   8
Affiliations

Spleen volume is associated with overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with portal hypertension

Chun-Juan Zhao et al. World J Gastrointest Surg. .

Abstract

Background: Portal shunt and immune status related to the spleen are related to the occurrence of hepatic encephalopathy (HE). It is unknown whether spleen volume before transjugular intrahepatic portosystemic shunt (TIPS) is related to postoperative HE.

Aim: To investigate the relationship between spleen volume and the occurrence of HE.

Methods: This study included 135 patients with liver cirrhosis who underwent TIPS, and liver and spleen volumes were elevated upon computed tomography imaging. The Kaplan-Meier curve was used to compare the difference in the incidence rate of HE among patients with different spleen volumes. Univariate and multivariate Cox regression analyses were performed to identify the factors affecting overt HE (OHE). Restricted cubic spline was used to examine the shapes of the dose-response association between spleen volumes and OHE risk.

Results: The results showed that 37 (27.2%) of 135 patients experienced OHE during a 1-year follow-up period. Compared with preoperative spleen volume (901.30 ± 471.90 cm3), there was a significant decrease in spleen volume after TIPS (697.60 ± 281.0 cm3) in OHE patients. As the severity of OHE increased, the spleen volume significantly decreased (P < 0.05). Compared with patients with a spleen volume ≥ 782.4 cm3, those with a spleen volume < 782.4 cm3 had a higher incidence of HE (P < 0.05). Cox regression analysis showed that spleen volume was an independent risk factor for post-TIPS OHE (hazard ratio = 0.494, P < 0.05). Restricted cubic spline model showed that with an increasing spleen volume, OHE risk showed an initial increase and then decrease (P < 0.05).

Conclusion: Spleen volume is related to the occurrence of OHE after TIPS. Preoperative spleen volume is an independent risk factor for post-TIPS OHE.

Keywords: Cirrhosis; Hepatic encephalopathy; Portal hypertension; Spleen volume; Transjugular intrahepatic portosystemic shunt.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow diagram of patient inclusion. TIPS: Transjugular intrahepatic portosystemic shunt.
Figure 2
Figure 2
Kaplan-Meier curves for cumulative incidence of overt hepatic encephalopathy in patients with cirrhosis after transjugular intrahepatic portosystemic shunt stratified by spleen volume. The patients was divided into two groups based on the median splenic volume (784.2 cm3). Log-rank test was used to compare the cumulative incidence of overt hepatic encephalopathy between the two groups. OHE: Overt hepatic encephalopathy.
Figure 3
Figure 3
Comparison of spleen volumes among patients with different overt hepatic encephalopathy grades. The patients were divided in three groups based on overt hepatic encephalopathy (OHE) grade: Non-OHE (n = 99), OHE 2 (n = 18), and OHE 3/4 (n = 19). Quantitative data are presented as median (interquartile range). Mann-Whitney U test, aP < 0.05. OHE: Overt hepatic encephalopathy.
Figure 4
Figure 4
Comparison of spleen volumes pre- and post-transjugular intrahepatic portosystemic shunt. Paired t-test, aP < 0.05. TIPS: Transjugular intrahepatic portosystemic shunt.
Figure 5
Figure 5
Correlation between spleen volume and post-transjugular intrahepatic portosystemic shunt overt hepatic encephalopathy. A restricted cubic spline model was used to evaluate the dose-response relationship. S_VOL: Spleen volume.
See this image and copyright information in PMC

References

    1. Dib N, Oberti F, Calès P. Current management of the complications of portal hypertension: variceal bleeding and ascites. CMAJ. 2006;174:1433–1443. - PMC - PubMed
    1. Guixé-Muntet S, Quesada-Vázquez S, Gracia-Sancho J. Pathophysiology and therapeutic options for cirrhotic portal hypertension. Lancet Gastroenterol Hepatol. 2024;9(7):646–663. - PubMed
    1. Boike JR, Thornburg BG, Asrani SK, Fallon MB, Fortune BE, Izzy MJ, Verna EC, Abraldes JG, Allegretti AS, Bajaj JS, Biggins SW, Darcy MD, Farr MA, Farsad K, Garcia-Tsao G, Hall SA, Jadlowiec CC, Krowka MJ, Laberge J, Lee EW, Mulligan DC, Nadim MK, Northup PG, Salem R, Shatzel JJ, Shaw CJ, Simonetto DA, Susman J, Kolli KP, VanWagner LB Advancing Liver Therapeutic Approaches (ALTA) Consortium. North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension. Clin Gastroenterol Hepatol. 2022;20:1636–1662.e36. - PMC - PubMed
    1. Larrue H, D'Amico G, Olivas P, Lv Y, Bucsics T, Rudler M, Sauerbruch T, Hernandez-Gea V, Han G, Reiberger T, Thabut D, Vinel JP, Péron JM, García-Pagán JC, Bureau C. TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis. J Hepatol. 2023;79:692–703. - PubMed
    1. Nicoară-Farcău O, Han G, Rudler M, Angrisani D, Monescillo A, Torres F, Casanovas G, Bosch J, Lv Y, Thabut D, Fan D, Hernández-Gea V, García-Pagán JC Preemptive TIPS Individual Data Metanalysis, International Variceal Bleeding Study and Baveno Cooperation Study groups. Effects of Early Placement of Transjugular Portosystemic Shunts in Patients With High-Risk Acute Variceal Bleeding: a Meta-analysis of Individual Patient Data. Gastroenterology. 2021;160:193–205.e10. - PubMed