Correlation study between contrast-enhanced ultrasound-based stent blood flow assessment and post-TIPS complications in patients with cirrhosis
Authors: ye minyan , wu zhixian 
Published: October 2024

Objectives Transjugular intrahepatic portosystemic shunt (TIPS) is a vital procedure for alleviating portal hypertension in patients with cirrhosis, with an emphasis on preventing and minimizing complications. This study aims to explore the correlation between stent blood flow, as assessed by contrast-enhanced ultrasound (CEUS), and the occurrences of haemorrhage and hepatic encephalopathy in cirrhotic patients following TIPS. Additionally, the research seeks to develop and validate a clinical prediction model for the postoperative risks of haemorrhage and hepatic encephalopathy.
Methods A total of 102 patients with cirrhosis who received TIPS treatment at the 900th Hospital of the Joint Logistics Support Force from January 2021 to December 2022 were selected, and relevant clinical data and test results were collected. The stent average blood flow was calculated using the formula: Stent average blood flow (ml/min) =(stent length (cm)/time required for contrast agent to pass both ends of the stent (s) * stent cross-sectional area (cm2) *60. Independent predictors of postoperative haemorrhage in patients with cirrhosis were identified through univariate and multivariate Cox regression analysis. The optimal cut-off value for stent blood flow data was determined, and the predictive ability of stent average blood flow for haemorrhage after TIPS in cirrhotic patients was evaluated. Similarly, independent predictors of hepatic encephalopathy following TIPS in these patients were screened using the same approach, examining the effects of various stratified stent average blood flow values on the incidence of postoperative hepatic encephalopathy. Clinical prediction models for both haemorrhage and hepatic encephalopathy were then constructed separately.
Results 1. Among the 82 patients with liver cirrhosis who underwent TIPS and successfully completed liver CEUS, 12 patients experienced haemorrhage after the procedure. Multivariate analysis identified the average stent blood flow, postoperative portal vein pressure, and platelet count as independent predictors. When the average stent blood flow was at 31.62 ml/min, the sensitivity and specificity were 88.6% and 33.3%, respectively, with a Jorden index of 0.219. Stratified analysis of average stent blood flow indicated that the risk of postoperative haemorrhage increased when the average stent blood flow was below 31.62 ml/min, and this difference was statistically significant (P < 0.05). Twenty-six patients developed hepatic encephalopathy after TIPS. Multivariate Cox regression analysis revealed that diabetes, hypertension, and total bilirubin levels were independent predictors. When the average stent blood flow was at the optimal cut-off value of 29.93 ml/min, the corresponding sensitivity and specificity were 75.0% and 46.2%, respectively, with a Jorden index of 0.346. The risk of hepatic encephalopathy increased when the average postoperative stent blood flow exceeded 29.93 ml/min, and this difference was also statistically significant (P < 0.05).
2. The C-index for the clinical prediction models of post-TIPS haemorrhage and hepatic encephalopathy in patients with cirrhosis were 0.814 (95% CI: 0.633-0.996) and 0.712 (95% CI: 0.571-0.852), respectively. The area under the curve (AUC) of the haemorrhage prediction model at 1 year, 2 years, and 3 years were 0.881, 0.904, and 0.860, respectively. The AUC of the prediction model for hepatic encephalopathy after TIPS in cirrhotic patients was 0.786 in January, February, and March, indicating that the models demonstrated a certain degree of differentiation. The calibration curves fitted well, suggesting that they possess clinical practicality.
Conclusion 1. Stent blood flow assessment using contrast-enhanced ultrasound demonstrates predictive ability for haemorrhage after TIPS and the development of hepatic encephalopathy in patients with cirrhosis. 2. The clinical prediction models for post-TIPS haemorrhage and hepatic encephalopathy in cirrhotic patients exhibit clinical effectiveness.