Sarcopenia is a risk factor for post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy and mortality: A systematic review and meta-analysis

Zohaib Ahmed; Joyce Badal; Manesh Kumar Gangwani; Ahmad Nawaz; Bryan Badal; Syeda Faiza Arif; Umer Farooq; Faisal Kamal; Toseef Javaid; Muhammad Aziz; Wade Lee-Smith; Asif Mahmood; Nooraldin Merza; Abdallah Kobeissy; Ali Nawras; Mona Hassan

doi:10.1007/s12664-023-01465-2

Sarcopenia is a risk factor for post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy and mortality: A systematic review and meta-analysis

Indian J Gastroenterol. 2023 Dec 12. doi: 10.1007/s12664-023-01465-2. Online ahead of print.

Authors

Zohaib Ahmed¹, Joyce Badal^{2

3}, Manesh Kumar Gangwani⁴, Ahmad Nawaz⁵, Bryan Badal⁶, Syeda Faiza Arif⁷, Umer Farooq⁸, Faisal Kamal⁹, Toseef Javaid¹⁰, Muhammad Aziz¹⁰, Wade Lee-Smith¹¹, Asif Mahmood¹, Nooraldin Merza¹, Abdallah Kobeissy¹⁰, Ali Nawras¹⁰, Mona Hassan¹⁰

Affiliations

¹ Department of Internal Medicine, University of Toledo, Toledo, OH, USA.
² University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
³ Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Department of Internal Medicine, University of Toledo, Toledo, OH, USA. Gangwani.manesh@gmail.com.
⁵ Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA.
⁶ Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Richmond VA Medical Center, Richmond, VA, USA.
⁷ Dow University of Health Sciences, Karachi, Pakistan.
⁸ Department of Internal Medicine, Loyola Medicine/MacNeal Hospital, Chicago, IL, USA.
⁹ Department of Gastroenterology, University of California, Los Angeles, Los Angeles, CA, USA.
¹⁰ Department of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA.
¹¹ University of Toledo Libraries, University of Toledo, Toledo, OH, USA.

PMID: 38085501
DOI: 10.1007/s12664-023-01465-2

Abstract

Background/aims: Transjugular intrahepatic portosystemic shunt (TIPS) is a commonly performed procedure in patients with liver cirrhosis to treat portal hypertension-related conditions, including variceal bleeding and refractory ascites. However, while the increased risk of hepatic encephalopathy (HE) after TIPS is important to consider when determining whether a patient is a good candidate for TIPS, currently there is no widely used method to predict the development of post-TIPS HE, although the model for end-stage liver disease (MELD) score is used to predict post-TIPS mortality. We conducted a systematic review and meta-analysis to evaluate sarcopenia as a risk factor for HE and mortality in patients undergoing TIPS.

Methods: A comprehensive search strategy was used to identify reports of post-TIPS HE and mortality in sarcopenia vs. non-sarcopenia patients with liver cirrhosis who received TIPS in March 2023. Open Meta Analyst was used to compute the results.

Results: Twelve studies with 2056 patients met inclusion criteria and were included in the final meta-analysis. Sarcopenia was associated with a significantly higher post-TIPS HE rate than non-sarcopenia (risk ratio [RR]: 1.68, 95% CI: 1.48-1.92, p < 0.00001, I² = 65%), as well as a significantly higher post-TIPS mortality rate (RR: 1.73, 95% CI: 1.14-2.64, p < 0.00001, I² = 87%).

Conclusion: Patients with sarcopenia have a significantly increased risk of post-TIPS HE and mortality. Presence of sarcopenia should be considered when weighing the risks and benefits of performing TIPS in patients with cirrhosis. Further studies are needed to determine the clinical utility of important risk factors such as sarcopenia on post-TIPS outcomes.

Keywords: Liver encephalopathy; Meta-analysis; Muscle atrophy; Muscle wasting; Portocaval shunt; Refractory ascites; Sarcopenia; Systematic review; TIPS; Transjugular intrahepatic portacaval shunt; Transjugular intrahepatic portosystemic shunt; Variceal bleeding.

Publication types

Review