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World J Gastroenterol. Aug 7, 2026; 32(29): 118090
Published online Aug 7, 2026. doi: 10.3748/wjg.118090
Modified model incorporating sarcopenia and myosteatosis for predicting severe hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: Multicenter study
Jing-Qiu Zhang, Liang Yin, Yi-Jiang Zhu, Li Dong, Chang-Long Hou, Shi-Jiang Tian, Pin Chen, Xiang-Zhong Huang, Hao Xu, Zhi-Yang Chen, Xin-Jian Xu, Chun-Ze Zhou, De-Lei Cheng
Jing-Qiu Zhang, Zhi-Yang Chen, Graduate School of Bengbu Medical University, Bengbu 233030, Anhui Province, China
Liang Yin, Yi-Jiang Zhu, Li Dong, Chang-Long Hou, Chun-Ze Zhou, De-Lei Cheng, Department of Interventional Radiology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230000, Anhui Province, China
Shi-Jiang Tian, Pin Chen, Department of Interventional Radiology, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an 237000, Anhui Province, China
Xiang-Zhong Huang, Xin-Jian Xu, Department of Interventional Radiology, Jiangyin Hospital Affiliated to Nantong University, Jiangyin 214400, Jiangsu Province, China
Hao Xu, Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Co-first authors: Jing-Qiu Zhang and Liang Yin.
Co-corresponding authors: Xin-Jian Xu and De-Lei Cheng.
Author contributions: Zhang JQ and Yin L designed the research, analyzed the data, and wrote the initial draft of the manuscript as co-first authors; Zhu YJ, Dong L, Hou CL, and Tian SJ collected the data, analyzed the data, and designed the study; Chen P, Huang XZ, Xu H, and Chen ZY performed the research and collected the data; Xu XJ and Cheng DL have played important roles in the experimental design as co-corresponding authors; Xu XJ, Zhou CZ, and Cheng DL contributed to the central idea, designed the study, and wrote the manuscript; and all of the authors read and approved the final version of the manuscript to be published.
AI contribution statement: During the process of writing this paper, the software ChatGPT was used. ChatGPT was only used for language polishing. The AI tools did not participate in the design process of the research nor interpret the research results. None of the images in this manuscript were generated by AI.
Supported by the Hefei Natural Science Foundation, China, No. 202341.
Institutional review board statement: This study was approved by the Institutional Review Board of the First Affiliated Hospital of the University of Science and Technology of China (No. 2023-RE-283), the Institutional Review Board of Affiliated Hospital of Xuzhou Medical University (No. HX-2025-063-01), the Institutional Review Board of Jiangyin Hospital Affiliated to Nantong University (No. 2025-KY052-01), and the Institutional Review Board of Lu’an Hospital Affiliated to Anhui Medical University (No. 2025-KY056-01). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent statement: Due to the retrospective nature of this study, the need for informed consent was waived while ensuring the confidentiality of patient data and adhering to the Declaration of Helsinki.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Data sharing statement: The datasets generated and analyzed in the study are available from the corresponding author on reasonable request.
Corresponding author: De-Lei Cheng, MD, PhD, Professor, Department of Interventional Radiology, The First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei 230000, Anhui Province, China.
chengdelei@hotmail.com
Received: December 24, 2025
Revised: February 24, 2026
Accepted: April 15, 2026
Published online: August 7, 2026
Processing time: 206 Days and 5.8 Hours
BACKGROUND
Severe hepatic encephalopathy (SHE) following transjugular intrahepatic portosystemic shunt (TIPS) worsens the prognosis of cirrhotic patients. Despite established associations with nutritional and muscle-related factors, no integrated predictive model has yet been developed. This study developed and validated a model combining the Freiburg post-TIPS survival (FIPS) score with nutrition and sarcopenia-related indicators.
AIM
To develop and validate a predictive model combining the FIPS score with nutrition and sarcopenia-related indicators for SHE after TIPS.
METHODS
This retrospective study included 590 cirrhotic patients who underwent TIPS at four Chinese hospitals between April 2015 and March 2025. Patients from Center I were divided into training and internal validation cohorts at a ratio of 7:3, while those from the remaining centers formed the external validation cohort. Independent risk factors identified via Cox regression were incorporated into a base model using FIPS and preoperative computed tomography-derived nutrition-sarcopenia indices. Model performance was evaluated in terms of discrimination (concordance index and area under the receiver operating characteristic curve), calibration, and clinical utility.
RESULTS
Independent predictors of post-TIPS SHE included FIPS [hazard ratio (HR) = 1.753; 95%CI: 1.266-2.428; P = 0.001], myosteatosis (HR = 1.921; 95%CI: 1.114-3.312; P = 0.019), and sarcopenia (HR = 2.722; 95%CI: 1.596-4.641; P < 0.001). The modified model demonstrated area under the receiver operating characteristic curves of 0.766, 0.745, and 0.751 at 3 months, 6 months, and 12 months in the training cohort; 0.733, 0.718, and 0.793 in the internal validation cohort; and 0.811, 0.797, and 0.854 in the external validation cohort, respectively, outperforming the original FIPS score. Predictive accuracy improved by 4.4% (P = 0.001), with calibration and decision curve analyses confirming its clinical utility.
CONCLUSION
The modified model demonstrated superior predictive performance for post-TIPS SHE and provides a reliable tool for risk stratification and clinical decision-making.
Core Tip: In recent years, transjugular intrahepatic portosystemic shunt (TIPS) has been widely applied in patients with portal hypertension. TIPS is characterized by its minimally invasive nature, proven efficacy, and rapid postoperative recovery, making it a primary treatment option for portal hypertension. However, the development of postoperative hepatic encephalopathy remains a major challenge associated with this technique. Existing predictive scoring models for this complication are limited. This study proposes a novel risk prediction model incorporating nutritional status-related indicators and the Freiburg post-TIPS survival score, which identifies patients at high risk of severe hepatic encephalopathy following TIPS and provides guidance for clinical decision-making.
