Comparative study of indocyanine green-R15, Child-Pugh score, and model for end-stage liver disease score for prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

doi:10.3748/wjg.v27.i5.416

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Feb 7, 2021 (publication date) through Mar 6, 2025

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Feb 7, 2021; 27(5): 416-427
Published online Feb 7, 2021. doi: 10.3748/wjg.v27.i5.416

Table 1 Patients’ preoperative characteristics

Parameter	Patients enrolled (n = 195)	Patients without post-TIPS HE (n = 150)	Patients with post-TIPS HE (n = 45)	P value
Age (years)¹	51.2 ± 11.4	49.8 ± 13.2	58.3 ± 9.9	0.004^b
Gender (F/M), n²	140/55			0.79
TIPS indication, n²				0.10
Variceal bleeding	118 (60.7)	93	25
Ascites	36 (18.5)	29	7
Bleeding combine with ascites	27 (14.1)	21	6
Other	14 (6.7)	7	7
Cirrhotic aetiology, n²				0.98
Viral	146 (74.9)	111	35
Alcoholic	31 (15.9)	25	6
Biliary	9 (4.6)	7	2
Drug-induced	4 (2)	3	1
Autoimmune	5 (2.6)	4	1
Preoperative HVPG, mmHg³	17.1 (11, 23)	18 (13, 21)	20 (12, 20)	0.28
Preoperative PPG, mmHg³	23 (18, 29)	23 (16, 29)	23 (20, 28)	0.6
Stent size, mm (%)²				0.057
7	59 (30.4)	51	8
8	117 (60)	87	30
10	19 (9.6)	12	7
Puncture site of portal vein, n²				0.013^a
Left branch	113 (57.7)	96	17
Bifurcation	22 (11.1)	15	7
Right branch	60 (31.2)	40	20
Child-Pugh score¹	7.1 ± 1.5	7.0 ± 1.6	8.0 ± 2.1
Child-Pugh grade, n²				0.029^a
A	108 (55.6)	89	19
B	75 (38.5)	55	20
C	12 (5.9)	6	6
MELD score³	7.0 (4.1, 10.0)	6.5 (3.8, 10.0)	7.9 (5.8, 13.0)	0.07
ICG-R15, %³	38.4 (22, 50)	34.6 (21.8, 47.7)	44.4 (35.4, 63.0)	0.013^a
Total protein, g/L¹	64.0 ± 9.0	64.6 ± 9.6	61.8 ± 6.9	0.19
Total bilirubin, μmoL/L³	24.5 (16.8, 35.4)	24.0 (16.9, 35.2)	29.8 (19.5, 44.5)	0.169
Creatinine, μmoL/L³	63 (52, 77)	61 (52, 73)	70 (59, 85)	0.084
ALT, U/L³	21 (15, 33)	22 (16, 33)	21 (16, 29)	0.889
AST, U/L³	28 (20, 42)	28 (20, 44)	31 (23, 50)	0.442
ALP, U/L³	91 (67, 122)	90 (67, 131)	92 (65, 121)	0.39
Albumin, g/L¹	34.9 ± 5.4	33.4 ± 5.2	35.2 ± 6.9	0.12
Serum potassium, mmoL/L¹	4.0 ± 0.5	3.9 ± 0.3	4.0 ± 0.4	0.62
Serum clozapine, mmoL/L¹	105.2 ± 5.8	105.3 ± 5.4	105.5 ± 6.6	0.81
Serum sodium, mmoL/L¹	138.7 ± 5.1	136.2 ± 4.9	140.7 ± 6.1	0.39
WBC, × 10⁹/L³	3.27 (2.1, 4.6)	3.1 (2.1, 4.4)	3.3 (2.5, 5.7)	0.26
Platelet count, × 10⁹/L³	80 (58.3, 120)	85 (61.2, 127.7)	83 (63, 107)	0.49
Hb, g/L¹	97.4 ± 27.1	95.3 ± 25.5	98.1 ± 27.9	0.9
BUN, mmoL/L³	5.7 (4.3, 7.7)	5.4 (4.2, 7.0)	7.6 (5.4, 8.8)	0.07
NH₃, μg/Dl¹	49.5 ± 19.5	46.6 ± 15.4	54.9 ± 23.8	0.037^a
APTT, s³	33.4 ± 4.4	33.8 ± 4.5	33.5 ± 4.2	0.76
INR¹	1.4 ± 0.3	1.37 ± 0.3	1.32 ± 0.19	0.50
FIB, g/L¹	2.17 ± 0.8	2.2 ± 0.8	2.3 ± 0.7	0.39
PT, s¹	14.8 ± 2.5	14.7 ± 2.6	14.4 ± 2.0	0.69

¹Values are the mean ± SD.

²Values are n.

³Values are medians (P25, P75).

^aP < 0.05.

^bP < 0.01. TIPS: Transjugular intrahepatic portosystemic shunt; HE: Hepatic encephalopathy; HVPG: Hepatic venous pressure gradient; PPG: Portal pressure gradient; MELD: Model for end-stage liver disease; ICG: Indocyanine green; ALT: Alanine aminotransferase; AST: Aspartate transaminase; ALP: Alkaline phosphatase; Hb: Hemoglobin; BUN: Blood urea nitrogen; APTT: Active partial thromboplastin; INR: International normalized ratio; FIB: Fibrinogen; PT: Prothrombin time; WBC: White blood cells.

Table 2 Univariable and multivariable logistic regression analyses of post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy

Parameter	Univariable logistic regression			Multivariable logistic regression
Parameter	Regression coefficient	OR	P value	Regression coefficient	OR	P value
Age	0.53	1.055	0.006^b	0.057	1.059	0.021^a
Gender (F/M)	0.134	1.143	0.789
TIPS indication (variceal bleeding/ascites/bleeding combined with ascites/other)	0.147	1.159	0.522
Cirrhotic aetiology (viral/alcoholic/biliary/drug-induced/autoimmune)	0.053	0.761	0.437
Preoperative HVPG	0.019	1.019	0.502
Preoperative PPG	0.022	1.023	0.289
Stent size (7/8/10)	-0.975	0.377	0.019^a
Puncture site of portal vein (left branch/bifurcation/right branch)	0.763	2.145	0.006^b	0.566	1.762	0.018^a
Child-Pugh score	0.027	1.027	0.022^a	0.053	1.055	0.046^a
Child-Pugh grade (A/B/C)	0.196	0.594	1.216
MELD score	0.256	1.291	0.020^a	0.516	1.068	0.043^a
ICG-R15	0.026	1.027	0.027^a	0.028	1.029	0.031^a
Total protein	-0.029	0.972	0.203
Total bilirubin	0.000	1.000	0.962
Creatinine	0.006	1.006	0.151
ALT	0.000	1.000	0.892
AST	0.003	1.003	0.232
ALP	0.002	1.002	0.248
Albumin	-0.058	0.94	0.1364
Serum potassium	0.233	1.262	0.689
Serum clozapine	0.007	1.007	0.864
Serum sodium	-0.035	0.965	0.395
WBC	0.047	1.049	0.544
Platelet count	-0.003	0.997	0.359
Hb	-0.001	0.999	0.908
BUN	0.084	1.087	0.025^a	0.085	1.008	0.028^a
NH₃	0.025	1.025	0.044^a	0.032	1.033	0.025^a
APTT	-0.015	0.985	0.768
INR	-0.644	0.525	0.504
FIB	0.248	1.281	0.389
PT	-0.059	0.943	0.559

^aP < 0.05.

^bP < 0.01. TIPS: Transjugular intrahepatic portosystemic shunt; HVPG: Hepatic venous pressure gradient; PPG: Portal pressure gradient; MELD: Model for end-stage liver disease; ICG: Indocyanine green; ALT: Alanine aminotransferase; AST: Aspartate transaminase; ALP: Alkaline phosphatase; Hb: Hemoglobin; BUN: Blood urea nitrogen; APTT: Active partial thromboplastin; INR: International normalized ratio; FIB: Fibrinogen; PT: Prothrombin time; WBC: White blood cell.

Table 3 Areas under the receiver operating characteristic curves of indocyanine green rentention rate of 15 min, Child-Pugh score, and model for end-stage liver disease score

Parameter	CPS	MELD	ICG-R15
AUC	0.596	0.641	0.664
95%CI	0.508-0.679	0.554-0.721	0.557-0.743
Z statistic	1.709	2.293	2.832
P value	0.087	0.021^a	0.0046^b
Youden index J	0.211	0.269	0.307
Cut-off value	6	7.5	30
Sensitivity	78.2	60.87	86.96
Specificity	42.6	66.07	43.75

^bP < 0.01. ICG: Indocyanine green; CPS: Child-Pugh score; MELD: Model for end-stage liver disease; AUS: Areas under the receiver operating characteristic curves.

Table 4 Characteristics of patients with an indocyanine green rentention rate at 15 min ≤ 30% and > 30%

Characteristic	ICG-R15 ≤ 30% (n = 69)	ICG-R15 > 30% (n = 126)	P value
HE/non HE¹	9 (13%)/60	36 (28.5%)/90	0.014^a
Age (yr)²	48.3 ± 11.6	52.9 ± 14.1	0.033^a
Child-Pugh score²	6.3 ± 1.2	7.6 ± 1.6	< 0.001^c
Preoperative PPG, mmHg³	15.6 (11, 18)	18 (16, 24)	0.005^b
NH₃, μg/dL²	45.0 ± 15.0	52.0 ± 21.2	0.021^a
Albumin, g/L²	38.0 ± 4.4	33.3 ± 5.6
AST, U/L³	25 (18, 36)	28.5 (22, 45.7)	0.018^a
Serum clozapine, mmoL/L²	106.6 ± 4.8	104.5 ± 5.9	0.024^a
Serum sodium, mmoL/L²	140.4 ± 3.7	137.7 ± 5.5	< 0.001^c
WBC, × 10⁹/L³	2.77 (1.81, 3.86)	3.6 (2.3, 4.9)	0.031^a
APTT, s³	32.8 ± 3.2	34.3 ± 5.0	0.024^a
PT, s²	14.0 ± 1.9	15.3 ± 2.6	0.043^a

¹Values are n.

²Values are the mean ± SD.

³Values are medians (P25, P75).

^aP < 0.05.

^bP < 0.01.

^cP < 0.001. ICG: Indocyanine green; HE: Hepatic encephalopathy; PPG: Portal pressure gradient; AST: Aspartate transaminase; APTT: Active partial thromboplastin; PT: Prothrombin time; WBC: White blood cells.

Citation: Wang Z, Wu YF, Yue ZD, Zhao HW, Wang L, Fan ZH, Zhang Y, Liu FQ. Comparative study of indocyanine green-R15, Child-Pugh score, and model for end-stage liver disease score for prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2021; 27(5): 416-427
URL: https://www.wjgnet.com/1007-9327/full/v27/i5/416.htm
DOI: https://dx.doi.org/10.3748/wjg.v27.i5.416