Evidence map›Paper›PMID 41315897›Full record

ArticleAlimentary pharmacology & therapeutics2026

Diabetes Mellitus is a Risk Factor for Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt.

Michelle Spaan, Ellen Werner, Willemijn Dijkstra, Nicole E Erler, Diederik Bijdevaate, Sarwa Darwish Murad, Milan J Sonneveld, Caroline M den Hoed, Anne van Eldere, Dave S Sprengers and 7 more

Abstract read
In one paragraph

Article in Alimentary pharmacology & therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Michelle SpaanDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Ellen WernerDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Willemijn DijkstraDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Nicole E ErlerDepartment of Epidemiology and Statistics, Erasmus MC, Rotterdam, the Netherlands.
Diederik BijdevaateDepartment of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
Sarwa Darwish MuradDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Milan J SonneveldDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0002-9253-563X
Caroline M den HoedDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Anne van EldereDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Dave S SprengersDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Willem-Pieter BrouwerDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0001-8713-1481
Robert J de KnegtDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0003-0934-6975
Harry L A JanssenDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Kay PietermanDepartment of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
Sandra CoenenDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.
Raoel MaanDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.ORCID https://orcid.org/0000-0001-6402-398X
Adriaan J van der MeerDepartment of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTransjugular intrahepatic portosystemic shunt (TIPS) placement effectively decreases portal pressure in patients with decompensated cirrhosis. However, many patients develop hepatic encephalopathy (HE) post-TIPS. We investigated the relation between the presence of Diabetes Mellitus (DM) and the occurrence of HE following TIPS placement in patients with cirrhosis.

methodsIn this retrospective cohort study all patients with cirrhosis who received a TIPS from 2007 through 2021 were included. Baseline characteristics and decompensating events including hospital admission for HE were recorded. In cases where hospital admission was required, HE was considered severe.

resultsIn total, 325 patients were included and 113 (34.8%) had DM at the time of TIPS placement. One hundred and fifty-one patients developed HE of whom 86 (57.0%) were hospitalised. The cumulative 6-month incidences of HE and severe HE were 45.2% (95% CI 39.5-51.8) and 25.1% (95% CI 20.2-31.3), respectively. Multivariable Cox regression with competing risk analyses demonstrated that DM was independently associated with the risk of both HE (aHR 1.56, 95% CI 1.08-2.26, p = 0.018) and severe HE (aHR 1.76, 95% CI 1.07-2.90, p = 0.026). These associations were independent of the relation between HE and age (aHR 1.03, 95% CI 1.01-1.05, p < 0.001) or MELD-Na score (aHR 1.07, 95% CI 1.03-1.10, p < 0.001).

conclusionsThis study highlights the high incidence of HE following TIPS and shows that DM is a significant and independent risk factor for the development of HE. Given the increase in patients with metabolic dysfunction-associated liver cirrhosis and DM, this study offers additional insights into the balance of risks and benefits associated with TIPS placement.

Indexed as

Diabetes MellitusHepatic EncephalopathyLiver CirrhosisPortasystemic Shunt, Transjugular IntrahepaticAdultAgedFemaleHumansIncidenceMaleMiddle AgedRetrospective StudiesRisk Factors

Identifiers

PMID41315897
PMCPMC12982642

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.