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Low adipose tissue index as an indicator of hepatic encephalopathy in cirrhotic patients following transjugular intrahepatic portosystemic shunt

  • Hepatobiliary
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Abstract

Purpose

We aimed to investigate the predictive value of body compositions measured by CT, including skeletal muscle and adipose tissue, for hepatic encephalopathy (HE) in cirrhotic patients following transjugular intrahepatic portosystemic shunt (TIPS).

Methods

Patients who underwent TIPS between November 2015 and April 2021 were included in this retrospective study. CT images taken at L3 were quantified for three body composition indexes (cm2/m2), visceral fat area index (VFAI), subcutaneous fat area index (SFAI), and skeletal muscle index (SMI) at baseline. Multivariable logistic regression models were conducted to assess associations between post-TIPS HE and body compositions. Nomograms based on the multivariable logistic regression models were developed and were evaluated from Calibration curves.

Results

Male patients had greater SMI, whereas SFAI and VFAI were higher in females (p < 0.001 for each). In sex stratified multivariate analyses after adjustment for other confounding variables, VFAI in males (p = 0.033) and SFAI in females (p = 0.003) were significant predictors of post-TIPS HE. Male patients with low VFAI (< 53.52 cm2/m2) (OR 6.44; 95% CI 1.72–23.59; p = 0.006) and female patients with low SFAI (< 70.05 cm2/m2) (OR 10.55; 95% CI 2.36–46.23; p = 0.002) had a higher risk of post-TIPS HE. Risk factors in the nomogram contributing to the male model included age, height, Child–Pugh score, and low VFAI; pre-albumin and low SFAI were contributed to female model.

Conclusion

Body compositions could not only be noninvasively used for nutritional assessment, but also be utilized to predict HE risk of cirrhotic patients after TIPS.

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Acknowledgements

The authors would like to acknowledge all participants with hepatic encephalopathy and all cirrhotic patients treated with transjugular intrahepatic portosystemic shunt who allowed us to conduct this study in an effort to improve the lives of patients with cirrhosis.

Funding

This work was supported by the program for Gusu Medical Talent of Suzhou City [Grant Number GSWS2020009]; and the Translational Research Grant of NCRCH [Grant Number 2020WSB06].

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Author notes

  1. Chuhan Wang, Yue Teng and ** Gao are co-first authors.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, People’s Republic of China

    Chuhan Wang, Yue Teng & Yonggang Li

  2. State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, 215123, China

    ** Gao

  3. Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, People’s Republic of China

    Zichen Zhang

  4. Institute of Medical Imaging, Soochow University, Suzhou, 215000, Jiangsu, People’s Republic of China

    Yonggang Li

  5. National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, No. 899, **hai Road, Suzhou, 215000, Jiangsu, People’s Republic of China

    Yonggang Li

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Contributions

Concept and design: CW, YT, ZZ; Administrative support: JG, YL; Provision of study materials or patients: YL; Collection and assembly of data: CW, ZZ; Data analysis and interpretation: CW, JG; Manuscript writing: CW; Final approval of manuscript: All authors.

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Correspondence to Yonggang Li.

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Wang, C., Teng, Y., Gao, J. et al. Low adipose tissue index as an indicator of hepatic encephalopathy in cirrhotic patients following transjugular intrahepatic portosystemic shunt. Abdom Radiol 48, 1454–1467 (2023). https://doi.org/10.1007/s00261-023-03813-4

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