ArticleUnited European gastroenterology journal2025
Plasma Ammonia Levels Predict Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.
Article in United European gastroenterology journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04801290 (Benefits and Limitations of Transjugular Intrahepatic Portosystemic Shunts), which is not on this map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Benefits and Limitations of Transjugular Intrahepatic Portosystemic Shunts (TIPS) in Patients With Decompensated Liver Cirrhosis
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk factors for hepatic encephalopathy in patients following transjugular intrahepatic portosystemic shunt: a meta-analysis and systematic review.BMC surgery · 2026Pooled it
- Plasma Ammonia Levels Predict Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt Placement.United European gastroenterology journal · 2025Article
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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPlacement of a transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for portal hypertension. Overt hepatic encephalopathy (oHE) is a complication after TIPS associated with increased morbidity. Elevated ratio of plasma ammonia (AMM) levels compared to the local upper limit of normal (ULN) has been associated with oHE, hepatic complications and increased mortality in patients with cirrhosis without TIPS. The role of AMM in risk stratification of post-TIPS oHE is unclear.
objectiveTo investigate the role of AMM in the prediction of oHE in patients receiving TIPS placement.
methodsPatients with TIPS placement were recruited within a prospective observational study protocol with follow-up (FU) visits at 1, 3, 6, and 12 months after TIPS. Post hoc analyses of AMM levels for the association with the primary (oHE) and secondary endpoints (hepatic decompensation, infections, death/liver transplantation) during the first year after TIPS placement were performed.
resultsOf 188 patients with TIPS placement, 148 patients with available baseline AMM levels were included. During follow-up, 37% (55/148) of patients developed oHE. In multivariable competing risk analysis, baseline AMM/ULN (HR 2.03 [CI 1.42-2.89], p = 0.001) and Freiburg index of post-TIPS survival (FIPS) score (HR 1.52 [CI 1.03-2.24], p = 0.037) were independently associated with oHE. The published cut-off AMM/ULN > 1.4 showed comparable results (HR 2.40 [CI 1.24-4.65], p = 0.01). AMM at FU1 was available in 100 patients, of whom 28% (28/100) developed oHE after FU1. In multivariable competing risk analysis, AMM/ULN (HR 5.48 [CI 2.37-12.67], p < 0.001), psychometric hepatic encephalopathy score (HR 0.86 [0.78-0.96], p = 0.005) and FIPS (HR 3.57 [CI 1.79-7.14], p < 0.001) at FU1 were independently associated with oHE after FU1. No significant association between AMM/ULN and the secondary endpoints was detected.
conclusionAMM levels before TIPS are independently associated with oHE after TIPS placement. AMM levels may serve as an additional marker for risk stratification of patients.
trial registrationClinical trial number NCT04801290.
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