Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2054-2064
Published online Jul 27, 2024. 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, Chao Ren, Zhen Yuan, Guo-Hui Bai, Jin-Yu Li, Long Gao, Jin-Hui Li, Ze-Qi Duan, Dui-Ping Feng, Hui Zhang
Chun-Juan Zhao, Chao Ren, Guo-Hui Bai, Jin-Hui Li, Hui Zhang, College of Medical Imaging, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Chun-Juan Zhao, Hui Zhang, Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Zhen Yuan, Department of Occupational Health, School of Public Health, Shanxi Key Laboratory of Environmental Health Impairment and Prevention, NHC Key Laboratory of Pneumoconiosis, MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Jin-Yu Li, Long Gao, Dui-Ping Feng, Department of Oncological and Vascular Intervention, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Jin-Yu Li, Long Gao, Dui-Ping Feng, Shanxi Provincial Clinical Research Center for Interventional Medicine, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Ze-Qi Duan, First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Hui Zhang, Shanxi Key Laboratory of Intelligent Imaging and Nanomedicine, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Hui Zhang, Intelligent Imaging Big Data and Functional Nano-imaging Engineering Research Center of Shanxi Province, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Co-corresponding authors: Dui-Ping Feng and Hui Zhang.
Author contributions: Zhao CJ, Gao L, Feng DP, and Zhang H contributed to study conception and design; Zhao CJ, Bai GH, Li JY, and Duan ZQ contributed to data acquisition; Ren C, Yuan Z, Li JH, and Feng DP contributed to data analysis and interpretation; Zhao CJ, Ren C, Feng DP, and Zhang H contributed to manuscript writing, critical revision of the manuscript, and statistical analysis; and all authors vouched for the veracity and completeness of the data and analyses presented, and reviewed and approved the final version of the manuscript. Zhang H and Feng DP contributed equally to the work and should be regarded as co-corresponding authors.
Supported by National Natural Science Foundation of China (General Program), No. 82200650; the Key Research and Development Projects of Shanxi Province, No. 202102130501014; and the Natural Science Foundation of Shanxi Province, No. 202203021211021, No. 202203021212046, and No. 20210302123258.
Institutional review board statement: The Institutional Review Board of First Hospital of Shanxi Medical University approved this study (Approval No. K-K231).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data can be acquired from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Zhang, PhD, Professor, College of Medical Imaging, Shanxi Medical University, No. 56 Xinjian South Road, Yingze District, Taiyuan 030001, Shanxi Province, China. zhang_hui@sxmu.edu.cn
Received: February 26, 2024
Revised: May 6, 2024
Accepted: May 27, 2024
Published online: July 27, 2024
Processing time: 147 Days and 3.8 Hours
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: Hepatic encephalopathy; Transjugular intrahepatic portosystemic shunt; Spleen volume; Portal hypertension; Cirrhosis

Core Tip: This study included 135 patients with liver cirrhosis who underwent transjugular intrahepatic portosystemic shunt (TIPS), and spleen volumes were elevated by computed tomography-scan imaging. The results showed that there was a significant decrease in spleen volume after TIPS in overt hepatic encephalopathy (OHE) patients. The patients with a smaller spleen volume had a higher incidence of HE. Preoperative spleen volume was an independent risk factor for postoperative OHE in TIPS. In conclusion, spleen volume is closely related to the occurrence of OHE after TIPS. Preoperative spleen volume is an independent risk factor for post-TIPS OHE.