Premium
The modification of quantity and quality of muscle mass improves the cognitive impairment after TIPS
Author(s) -
Gioia Stefania,
Merli Manuela,
Nardelli Silvia,
Lattanzi Barbara,
Pitocchi Francesca,
Ridola Lorenzo,
Riggio Oliviero
Publication year - 2019
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14050
Subject(s) - hepatic encephalopathy , medicine , sarcopenia , wasting , gastroenterology , liver disease , model for end stage liver disease , cirrhosis , cognitive impairment , skeletal muscle , disease , liver transplantation , transplantation
Background Hepatic encephalopathy (HE) is the major complication of transjugular intrahepatic portosystemic shunt (TIPS). In cirrhotic patients, a correlation between sarcopenia and HE has been suggested. Aim To evaluate the evolution of the skeletal muscle quantity and quality at CT scan and of the patients' cognitive impairment (both overt and minimal HE) before and after TIPS. Patients and Methods Twenty‐seven cirrhotic patients submitted to TIPS were studied. The modification of Skeletal Muscle Index (SMI), muscle attenuation, HE and plasma ammonia were evaluated before and after a mean follow‐up of 9.8 ± 4 months after TIPS. Results During the follow‐up, the mean SMI and muscle attenuation increased significantly, although not uniformly in all patients. Psychometric Hepatic Encephalopathy Score (PHES) and ammonia improved significantly in the patients with amelioration in SMI >10% (n = 16) and not in those without (n = 11) (PHES: −1.6 ± 2 vs −4.8 ± 2.1; P = 0.0005; ammonia: 48.5 ± 28.7 vs 96 ± 31.5 μg/dL; P = 0.0004). Moreover, the prevalence of minimal HE (12.5% vs 73%, P = 0.001) as well as the number of episodes of overt HE during the follow‐up were significantly reduced in the patients with improved SMI. Model for end‐stage liver disease remained stable or worsened after TIPS and was not significantly different between the groups with or without SMI improvement. Conclusion The amelioration of muscle wasting and HE independent of liver function observed after TIPS supports the causal relationship between muscle wasting and HE.