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No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

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Abstract

Hepatic encephalopathy (HE) is a major problem in patients submitted to TIPS. Previous studies identified low albumin as a factor associated to post-TIPS HE. In cirrhotics with diuretic-induced HE and hypovolemia, albumin infusion reduced plasma ammonia and improved HE. Our aim was to evaluate if the incidence of overt HE (grade II or more according to WH) and the modifications of venous blood ammonia and psychometric tests during the first month after TIPS can be prevented by albumin infusion. Twenty-three patients consecutively submitted to TIPS were enrolled and treated with 1 g/Kg BW of albumin for the first 2 days after TIPS followed by 0,5 g/Kg BW at day 4th and 7th and then once a week for 3 weeks. Forty-five patients included in a previous RCT (Riggio et al. 2010) followed with the same protocol and submitted to no pharmacological treatment for the prevention of HE, were used as historical controls. No differences in the incidence of overt HE were observed between the group of patients treated with albumin and historical controls during the first month (34 vs 31 %) or during the follow-up (39 vs 48 %). Two patients in the albumin group and three in historical controls needed the reduction of the stent diameter for persistent HE. Venous blood ammonia levels and psychometric tests were also similarly modified in the two groups. Survival was also similar. Albumin infusion has not a role in the prevention of post-TIPS HE.

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Abbreviations

TIPS:

Transjugular intrahepatic portosystemic shunt

DST:

Digit-symbol test

TMT-A:

Trail-making test A

TMT-B:

Trail-making test B

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Acknowledgments

The study was partially supported by W.L. GORE and Associated which is the producer of the stents used in the study for TIPS costruction.

Conflict of interest

The authors declare that no conflict of interest exists concerning this paper.

Author contributions

Oliviero Riggio: study concept and design, analysis and interpretation of data; manuscript preparation; final drafting of the manuscript; study supervision.

Silvia Nardelli: acquisition and analysis of data.

Chiara Pasquale: acquisition and analysis of data.

Ilaria Pentassuglio: acquisition of data.

Stefania Gioia: acquisition of data

Eugenia Onori: acquisition of data

Camilla Frieri: acquisition of data

Manuela Merli: critical discussion and support, manuscript revision for important intellectual content.

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Authors and Affiliations

  1. Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension “Sapienza” University of Rome, Rome, Italy

    Oliviero Riggio, Silvia Nardelli, Chiara Pasquale, Ilaria Pentassuglio, Stefania Gioia, Eugenia Onori, Camilla Frieri, Filippo Maria Salvatori & Manuela Merli

  2. Centro di Riferimento per l’Ipertensione Portale, II Gastroenterologia, Dipartimento di Medicina Clinica, “Sapienza” Università di Roma, Viale dell’Università 37, 00185, Roma, Italy

    Oliviero Riggio

Authors
  1. Oliviero Riggio
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  2. Silvia Nardelli
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  3. Chiara Pasquale
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  4. Ilaria Pentassuglio
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  5. Stefania Gioia
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  6. Eugenia Onori
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  7. Camilla Frieri
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  8. Filippo Maria Salvatori
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  9. Manuela Merli
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Corresponding author

Correspondence to Oliviero Riggio.

Additional information

Key points

• hepatic encephalopathy (HE) is very frequent in patients submitted to TIPS

• A previous study (Riggio et al. 2008) identified high creatinine levels low serum sodium and albumin as associated to post TIPS HE, suggesting that the correction of hypovolemia might be useful in HE prevention

• In our study no differences in the incidence of overt HE were observed between the group of patients treated with albumin and historical controls during the first month (34 vs 31 %) or during the follow-up (39 vs 48 %). Thus albumin infusion has not a role in the prevention of HE after a TIPS.

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Riggio, O., Nardelli, S., Pasquale, C. et al. No effect of albumin infusion on the prevention of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. Metab Brain Dis 31, 1275–1281 (2016). https://doi.org/10.1007/s11011-015-9713-x

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  • DOI: https://doi.org/10.1007/s11011-015-9713-x

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