Abstract
Objective: Hepatic encephalopathy (HE) is one of the common complications after transjugular intrahepatic portosystemic shunting (TIPS). About one third of patients suffers from new or worsening HE after TIPS.
HE is associated with worse quality of life and increased mortality. The aim of the study was to describe in detail the cognitive changes in the patients undergoing transjugular intrahepatic portosystemic shunting.
Materials and Methods: This is a prospective cohort study of patients undergoing TIPS aged 18 and over. The patients were cognitively tested before TIPS, and one month and 6 months after TIPS.
We used standardized hepatic encephalopathy test (PHES). Results: We have assessed 25 patients (9 females, median age = 62).
Most of the patients already showed some signs of cognitive impairment prior to the TIPS (median PHES score = -6). There was a worsening in the cognitive performance median after TIPS in the overal sample, which is consistent with world literature (median PHES score = -9).
The PHES score then improved 6 months after TIPS (median PHES score = -5). However, there was a significant subgroup of 8 patients in the sample, who actually showed a significant improvement of cognitive functioning one month after TIPS procedure (Wilcoxon Signed-Rank Test, p = 0,005).
Conclusion: The worsening of median of performance is consistent with the world literature. However, the improvement of cognitive functioning soon after TIPS is rarely mentioned and it presents an exciting finding.
It is even more interesting that these patients were performing worse at baseline cognitive testing than the group of patients which worsened after TIPS. Future research could focus on this improved subgroup to see how they differ from the rest of the patients and try to identify some protective factors.