Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.

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  • Additional Information
    • Source:
      Publisher: Society of Cardiovascular and Interventional Radiology Country of Publication: United States NLM ID: 9203369 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1535-7732 (Electronic) Linking ISSN: 10510443 NLM ISO Abbreviation: J Vasc Interv Radiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: Reston, Va. : Society of Cardiovascular and Interventional Radiology, c1990-
    • Subject Terms:
      End Stage Liver Disease* ; Hepatic Encephalopathy*/etiology ; Portasystemic Shunt, Transjugular Intrahepatic*/adverse effects; Aged ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Social Class ; United States
    • Abstract:
      Purpose: To determine whether socioeconomic status (SES) is associated with hepatic encephalopathy (HE) risk after transjugular intrahepatic portosystemic shunt (TIPS) creation.
      Materials and Methods: This single-institution retrospective study included 368 patients (mean age = 56.7 years; n = 229 males) from 5 states who underwent TIPS creation. SES was estimated using the Agency for Healthcare Research and Quality SES index, a metric based on neighborhood housing, education, and income statistics. Episodes of new or worsening HE after TIPS creation, defined as hospitalization for HE or escalation in outpatient medical therapy, were identified from medical records. Multivariable ordinal regression, negative binomial regression, and competing risks survival analysis were used to identify factors associated with SES quartile, the number of episodes of new or worsening HE per unit time after TIPS creation, and mortality after TIPS creation, respectively.
      Results: There were 83, 113, 99, and 73 patients in the lowest, second, third, and highest SES quartiles, respectively. In multivariable regression, only older age (β = 0.04, confidence interval [CI] = 0.02-0.05; P < .001) and white, non-Hispanic ethnicity (β = 0.64, CI = 0.07-1.21; P = .03) were associated with higher SES quartile. In multivariable regression, lower SES quartile (incidence rate ratio [IRR] = 0.80, CI = 0.68-0.94; P = .004), along with older age, male sex, higher model for end-stage liver disease score, nonalcoholic steatohepatitis, and proton pump inhibitor use were associated with higher rates of HE after TIPS creation. Ethnicity was not associated with the rate of HE after TIPS creation (IRR = 0.77, CI = 0.46-1.29; P = .28). In multivariable survival analysis, neither SES quartile nor ethnicity predicted mortality after creation of a TIPS.
      Conclusion: Lower SES is associated with higher rates of new or worsening HE after TIPS creation.
      (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)
    • Comments:
      Comment in: J Vasc Interv Radiol. 2021 Jul;32(7):961-962. (PMID: 34210482)
    • Publication Date:
      Date Created: 20210305 Date Completed: 20211125 Latest Revision: 20211125
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/j.jvir.2020.11.022
    • Accession Number:
      33663923