OBJECTIVES Based on an artificial intelligence approach, this study attempted to establish prognostic models to predict 3-month overt hepatic encephalopathy (OHE) occurrence, 1-year mortality, and liver dysfunction for cirrhotic patients with acute variceal bleeding (AVB) treated with early transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS This retrospective study included patients treated with early TIPS between January 2016 and November 2019. Independent risk factors associated with occurrence of OHE within 3 months, 1-year mortality, and liver dysfunction after early TIPS were identified using univariate and multivariate logistic analyses. Artificial neural network (ANN) models and prognostic nomograms based on the independent risk factors were established and validated internally. RESULTS A total of 207 patients were included, with 33 (15.9%) experienced OHE within 3 months after TIPS creation. The albumin-bilirubin grade (P = 0.015), age (≤ 65, > 65 years) (P < 0.001), gender (P = 0.002), and alcoholic cirrhosis (P = 0.013) was identified as independent risk factors associated with 3-month OHE. Presence of portal vein thrombosis (P = 0.034) and model for end-stage liver disease score (P = 0.063) were identified as independent risk factors associated with 1-year mortality. The platelet-albumin-bilirubin grade (P = 0.041) and a history of hepatic encephalopathy (P = 0.018) were identified as independent risk factors associated with liver dysfunction after TIPS creation. Three ANN models and three nomograms were then established and validated with high accuracy. CONCLUSIONS The ANN and nomogram models have potential to accurately predict early occurrence of OHE, mortality, and liver dysfunction after early TIPS creation for cirrhotic patients with AVB.

中文翻译：

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使用人工智能对早期 TIPS 创建后脑病、死亡率和肝功能障碍进行预后预测的单中心回顾性培训队列。

目的 基于人工智能方法，本研究试图建立预后模型，以预测早期经颈静脉曲张静脉注射治疗的肝硬化急性静脉曲张出血 (AVB) 患者 3 个月明显肝性脑病 (OHE) 的发生率、1 年死亡率和肝功能障碍。肝内门体分流术 (TIPS) 创建。材料和方法 本回顾性研究纳入了 2016 年 1 月至 2019 年 11 月期间接受早期 TIPS 治疗的患者。使用单变量和多变量逻辑分析确定了与 3 个月内发生 OHE、1 年死亡率和早期 TIPS 后肝功能障碍相关的独立危险因素. 基于独立风险因素的人工神经网络 (ANN) 模型和预后列线图在内部建立和验证。结果 共纳入 207 名患者，其中 33 名 (15.9%) 在创建 TIPS 后 3 个月内经历了 OHE。白蛋白胆红素分级 (P = 0.015)、年龄 (≤ 65, > 65 岁) (P < 0.001)、性别 (P = 0.002) 和酒精性肝硬化 (P = 0.013) 被确定为与 3 -月OHE。门静脉血栓形成 (P = 0.034) 和终末期肝病模型评分 (P = 0.063) 被确定为与 1 年死亡率相关的独立危险因素。血小板-白蛋白-胆红素等级 (P = 0.041) 和肝性脑病史 (P = 0.018) 被确定为 TIPS 创建后与肝功能障碍相关的独立危险因素。然后建立并以高精度验证了三个 ANN 模型和三个列线图。