SynthesisBMC surgery2026
Risk factors for hepatic encephalopathy in patients following transjugular intrahepatic portosystemic shunt: a meta-analysis and systematic review.
Synthesis in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHepatic encephalopathy (HE) remains a major complication following transjugular intrahepatic portosystemic shunt (TIPS) placement. The objective of this study was to systematically evaluate and quantify risk factors for HE after TIPS through a meta-analysis.
methodsA comprehensive search of multiple databases was conducted from inception until December 16, 2025 to identify observational studies (cohort or case-control designs) investigating risk factors for HE in adult patients after TIPS. Literature screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS) were performed independently by two reviewers. Meta-analyses were conducted using Stata software. Odds ratios (ORs) or mean differences (MD) with 95% confidence intervals (CIs) were pooled for 26 potential risk factors. CLINICAL TRIAL NUMBER: not applicable.
resultsTwenty-seven studies (total 3,934 patients, 862 HE cases) were included. The overall methodological quality was moderate to high. Significant predictors of post-TIPS HE included advanced age (MD = 4.12 years, 95% CI: 2.68 to 5.56), Child-Pugh class C (OR = 2.87, 95% CI: 1.89 to 4.36), prior history of HE (OR = 3.28, 95% CI: 1.92 to 5.61), preoperative hyperammonemia (MD = 8.02 µmol/L, 95% CI: 4.15 to 11.89), hyponatremia (MD = -3.85 mmol/L, 95% CI: -4.72 to -2.98), significant pleural effusion (OR = 2.45, 95% CI: 1.28 to 4.68), and insufficient portal pressure gradient (PPG) reduction (MD = 2.31 mmHg, 95% CI: 1.15 to 3.47). Child-Pugh class A (OR = 0.45, 95% CI: 0.32 to 0.63) and the use of stents with a diameter ≥ 8 mm (OR = 0.58, 95% CI: 0.39 to 0.86) were protective factors.
conclusionThis meta-analysis identifies post-TIPS hepatic encephalopathy as a multifactorial condition determined by the interplay of hepatic functional reserve (Child-Pugh score, ammonia), patient characteristics (age, prior HE), electrolyte balance (sodium), hemodynamic response (PPG reduction), and procedural factors (stent diameter). The quantification of 26 distinct factors underscores the necessity of a comprehensive, multidimensional risk assessment that integrates metabolic, neurological, and hemodynamic profiles.
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