Purpose

We aimed to assess the efficacy of psoas density (PD) for predicting hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) procedures.

Methods

Data were collected from patients who underwent TIPS procedures at a single institution between 2013 and 2019. PD was manually measured using software on unenhanced CT scans at the level of third lumbar vertebra. Laboratory and physical examination data were collected within 24 h after admission in order to compare the differences between patients with and without post-TIPS HE.

Results

A total of 251 patients were included in this study. Among these patients, 77 (30.7%) developed post-TIPS HE within one year after TIPS creation. The threshold of PD for predicting HE was 51.24 Hounsfield unit (HU). PD values less than this threshold were correlated with an increased risk of HE (hazard ratio 0.92; 95% CI 0.89–0.95, P < 0.001). The area under the receiver operating characteristic curve (AUROC) of PD was 0.743 (95% CI 0.685–0.796), which was superior to Model for End-stage Liver Disease (MELD) (0.569, P = 0.007), albumin–bilirubin score (ALBI) (0.641, P = 0.018), and Child–Pugh score (0.583, P = 0.003).

Conclusion

PD measurement showed good HE predictive value in cirrhotic patients who underwent TIPS. This measure also performed better than MELD, ALBI and Child–Pugh.

中文翻译：

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腰大肌密度可预测接受经颈静脉肝内门体分流术的患者在 1 年内发生肝性脑病

目的

我们旨在评估腰大肌密度 (PD) 在预测经颈静脉肝内门体分流术 (TIPS) 后肝性脑病 (HE) 的功效。

方法

数据是从 2013 年至 2019 年间在一个机构接受 TIPS 手术的患者收集的。 PD 是使用软件在第三腰椎水平的非增强 CT 扫描上手动测量的。入院后 24 小时内收集实验室和体格检查数据，以比较 TIPS 后 HE 患者与非 TIPS HE 患者之间的差异。

结果

本研究共纳入 251 名患者。在这些患者中，77 名 (30.7%) 在 TIPS 创建后一年内发生了 TIPS 后 HE。预测 HE 的 PD 阈值为 51.24 Hounsfield 单位 (HU)。小于该阈值的 PD 值与 HE 风险增加相关（风险比 0.92；95% CI 0.89–0.95，P  < 0.001）。PD的受试者工作特征曲线下面积（AUROC）为0.743（95% CI 0.685-0.796），优于终末期肝病模型（MELD）（0.569，P  = 0.007），白蛋白-胆红素评分(ALBI) (0.641, P  = 0.018) 和 Child-Pugh 评分 (0.583, P  = 0.003)。

结论

PD 测量在接受 TIPS 的肝硬化患者中显示出良好的 HE 预测价值。该指标的表现也优于 MELD、ALBI 和 Child-Pugh。