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

Table 1 Baseline characteristics of patients

Parameter	All patients (n = 135)
Demographic characteristics
Age, yr	57.8 ± 24.4
Gender, male	96 (59.6)
BMI	23.4 ± 9.4
Etiology
Viral (HAV/HBV/HCV)	3/52/9 (1.8/32.2/5.5)
Alcohol	24 (14.9)
Biliary	15 (9.3)
AIH	7 (4.3)
Others	51 (31.7)
Scores
Child-Pugh stage (A/B/C)	39/92/30 (24.2/57.1/18.6)
Child-Pugh score	7.9 ± 1.8
MELD score	13.6 ± 5.0
Imaging parameters
Spleen length, mm	147.3 ± 29.1
Spleen volume, cm3	853.0 ± 486.5
Liver volume, cm3	1125.0 ± 406.1
Liver/spleen volume	2.0 ± 2.8
OHE during follow-up
OHE during follow-up	37 (27.2)
OHE grade (2/3/4)	18/8/11 (13.2/5.9/8.1)
Median months	3
Laboratory parameters
WBC, 109/L	3.8 ± 3.1
PLT, 109/L	78.0 ± 66.0
INR	2.0 ± 5.3
ALT, U/L	29.1 ± 41.1
AST, U/L	41.3 ± 71.7
ALB, g/L	34.3 ± 23.9
TBIL, μmol/L	35.2 ± 34.7
Urea, mmol/L	7.3 ± 10.7
CRE, μmol/L	81.4 ± 104.4

Data are the mean ± SD, n (%), or median (interquartile range). BMI: Body mass index; HAV: Hepatitis A virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus; AIH: Autoimmune hepatitis; MELD: Model for end-stage liver disease; OHE: Overt hepatic encephalopathy; WBC: White blood cells; PLT: Platelets; INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TBIL: Total bilirubin; CRE: Creatinine.

Table 2 Comparison of population characteristics stratified by spleen volume

	Spleen volume ≥ 784.2 cm3 (n = 68)	Spleen volume < 784.2 cm3 (n = 67)	P value
Demographic characteristics
Age, yr	61.52 ± 0.42	57.07 ± 23.51	0.3427
Gender, male	43 (31.9)	36 (26.7)	0.2625
BMI	21.87 ± 4.32	23.51 ± 3.49	< 0.05
Etiology			0.3532
Viral	26 (38.2)	25 (37.3)
Alcohol	10 (14.7)	10 (14.9)
Biliary	7 (10.3)	8 (11.9)
AIH	3 (4.4)	2 (3.0)
Others	22 (32.4)	23 (34.3)
Scores
Child-Pugh stage			0.8530
A	17 (25.0)	16 (23.9)
B	36 (53.9)	38 (56.7)
C	15 (22.1)	13 (19.4)
Child-Pugh score	8.07 ± 1.82	7.88 ± 1.82	0.5090
MELD score	13.39 ± 4.36	13.93 ± 5.57	0.5920
OHE during follow-up
OHE grade			< 0.05
0/1	53 (77.9)	40 (59.7)
2	7 (10.3)	11 (16.4)
3	1 (1.5)	9 (13.4)
4	7 (10.3)	7 (10.4)
Laboratory parameters
WBC, 109/L	3.11 ± 2.63	4.18 ± 2.99	< 0.05
PLT, 109/L	60.38 ± 57.97	91.77 ± 67.64	< 0.01
INR	2.63 ± 8.05	1.56 ± 1.49	0.2941
ALT, U/L	29.55 ± 36.85	29.31 ± 51.22	0.9755
AST, U/L	34.09 ± 33.11	49.22 ± 105.00	0.2698
ALB, g/L	37.69 ± 36.24	31.80 ± 5.21	0.2000
TBIL, μmol/L	30.53 ± 17.13	41.71 ± 48.50	0.0845
Urea, mmol/L	5.61 ± 2.94	9.42 ± 15.95	0.0734
CRE, μmol/L	79.27 ± 82.35	78.97 ± 106.40	0.9861

Data are the mean ± SD, n (%), or median (interquartile range). BMI: Body mass index; AIH: Autoimmune hepatitis; MELD: Model for end-stage liver disease; OHE: Overt hepatic encephalopathy; WBC: White blood cells; PLT: Platelets; INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TBIL: Total bilirubin; CRE: Creatinine.

Table 3 Comparison of laboratory data and imaging parameters by overt hepatic encephalopathy stage

	Non-OHE (n = 99)	OHE/2 (n = 18)	OHE/3+4 (n = 19)	P value
WBC, 109/L	4.05 ± 3.44	2.51 ± 1.76	4.01 ± 2.44	0.1056
PLT, 109/L	78.61 ± 68.29	75.53 ± 75.37	74.96 ± 50.93	0.9579
INR	1.54 ± 1.39	1.38 ± 0.16	1.45 ± 0.23	0.8172
ALT, U/L	27.16 ± 29.84	17.29 ± 9.22	45.81 ± 78.55	< 0.05
AST, U/L	35.91 ± 30.42	26.66 ± 19.07	74.35 ± 161.60	< 0.05
ALB, g/L	35.21 ± 29.03	33.20 ± 4.87	32.03 ± 5.72	0.8144
TBIL, μmol/L	35.50 ± 39.82	28.60 ± 23.45	41.71 ± 31.00	0.4455
Urea, mmol/L	7.10 ± 9.17	9.78 ± 21.02	6.00 ± 3.30	0.4998
CRE, μmol/L	90.79 ± 127.20	66.29 ± 17.34	60.07 ± 16.12	0.3309
Spleen length, mm	150.90 ± 27.74	141.10 ± 35.44	143.00 ± 27.09	0.2619
Spleen volume, cm3	901.30 ± 471.90	882.30 ± 704.60	697.60 ± 281.00	< 0.05
Liver volume, cm3	1120.00 ± 360.80	1070.00 ± 456.00	1153.00 ± 534.60	0.1891
Liver/spleen volume	2.14 ± 3.07	2.59 ± 2.41	1.66 ± 1.08	0.5066

Data are the mean ± SD, or median (interquartile range). OHE: Overt hepatic encephalopathy; WBC: White blood cells; PLT: Platelets; INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TBIL: Total bilirubin; CRE: Creatinine.

Table 4 Univariable and multivariable Cox regression analyses of risk factors for post-transjugular intrahepatic portosystemic shunt overt hepatic encephalopathy

	Univariable Cox		Multivariable Cox
	HR (95%CI)	P value	HR (95%CI)	P value
Age (≥ 60 yr)	1.762 (1.043-3.230)	0.049	1.473 (0.834-3.929)	0.118
Gender	0.854 (0.449-1.575)	0.618
BMI (≥ 24.0)	0.689 (0.331-1.329)	0.288
Etiology (HBV)	1.799 (0.945-3.321)	0.065
Child-Pugh score	1.259 (0.587-2.470)	0.525
MELD score	1.279 (0.682-2.482)	0.451
Spleen volume	0.537 (0.283-0.986)	0.049	0.494 (0.234-0.929)	0.042
WBC, 109/L	1.129 (0.616-2.095)	0.696
PLT, 109/L	0.936 (0.512-1.707)	0.828

Cox: Cox proportional hazards model; TIPS: Transjugular intrahepatic portosystemic shunt; OHE: Overt hepatic encephalopathy; HR: Hazard ratio; BMI: Body mass index; HBV: Hepatitis B virus; MELD: Model for end-stage liver disease; WBC: White blood cells; PLT: Platelets.