Risk factors for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: A comprehensive minireview

Table 1 West Haven criteria for semi-quantitative grading of hepatic encephalopathy

Grade	Manifestation
Grade 0	No overt symptoms; mild cognitive impairment detectable only by specialized tests (e.g., neuropsychological tests)
Grade 1	Mild consciousness disturbance; euphoria and/or anxiety; inattention; impaired ability to perform simple addition
Grade 2	Lethargy or apathy; mild disorientation for time or place; subtle personality changes; inappropriate behavior; impaired ability to perform simple subtraction
Grade 3	Somnolence to semi-stupor but responsive to verbal stimuli; confusion; gross disorientation
Grade 4	Coma (unresponsive to verbal or painful stimuli)

Table 2 Research on risk factors for hepatic encephalopathy following transjugular intrahepatic portosystemic shunt

Ref.	Country	Research design, number of patients	Hepatic encephalopathy incidence (%)	Main risk factors	Effective interventions
Li et al[21]	China	Single-center, retrospective, n = 113	28.3	History of HE	Not reported
Zhuo et al[23]	China	Single-center, retrospective, n = 263	22.1	Diabetes, hyponatremia, portal vein pressure gradient > 12 mmHg	Not reported
Yin et al[24]	China	Single-center, retrospective, n = 108	45.4	Sarcopenia, Child–Pugh C, myosteatosis	Not reported
Luo et al[25]	China	Single-center, retrospective, n = 1244	Overall: Left branch group < right branch group	Portal vein puncture site	Left branch puncture reduced HE risk (P < 0.05)
Wang et al[26]	China	Single-center, retrospective, n = 127	8 mm group: 27.0; 10 mm group: 43.0	Stent diameter, advanced age	8 mm stent reduced HE risk (HR = 0.52)
Fonio et al[20]	Italy	Single-center, retrospective, n = 75	6 months: 36.0; 12 months: 27.0	Advanced age, Child–Pugh C, history of HE	Not reported
Casadaban et al[22]	United States	Single-center, retrospective, n = 191	42.0	History of HE, advanced age, low albumin	Not reported
Schepis et al[27]	Italy (Modena and Florence)	Multicenter, prospective, n = 95	Under-dilated stent: 27.0; control: 54.0	Excessive portal decompression (> 60%), Child–Pugh C	Under-dilated stent reduced HE risk
Bureau et al[29]	France	Multicenter, randomized controlled trial, n = 197	Rifaximin: 34.0; Placebo: 53.0	Not screened	Rifaximin prophylaxis reduced HE risk (HR = 0.52)
Kabelitz et al[28]	Hannover, Vienna, Hamburg	Multicenter, prospective, n = 1509	22.7	Portal pressure gradient reduction > 50%, Child–Pugh C, advanced age	Not reported

HE: Hepatic encephalopathy; HR: Hazard ratio.

Table 3 Incidence of hepatic encephalopathy following transjugular intrahepatic portosystemic shunt procedure with various stent diameters, n (%)

Type of stent	Incidence of hepatic encephalopathy
Uncovered stent (n = 130)	56/130 (43.1)
Diameter of stent: 8 mm (n = 47)	17/47 (36.1)
Diameter of stent: 10 mm (n = 83)	39/83 (47.0)
Covered stent (n = 574)	211/574 (36.8)
Diameter of stent: 6 mm (n = 94)	6/94 (6.4)
Diameter of stent: 7 mm (n = 178)	67/178 (37.6)
Diameter of stent: 8 mm (n = 302)	138/302 (45.7)