Improved clinical outcomes following embolization of extrahepatic portosystemic shunts in cirrhotic patients with recurrent hepatic encephalopathy

Table 1 Baseline characteristics of the participants, n (%)

Group	Control group (n = 8)	Treatment group (n = 8)	P value
Age (years)	57 (42-71)	63 (45-74)	0.269
Male	6 (75.0)	3 (37.5)	0.143
Etiology
HBV	1 (12.5)	0	0.044
Alcohol	7 (87.5)	5 (62.5)
Others	0	3 (37.5)
Number of HE episodes during the previous 12 months
1-2	4 (50.0)	5 (62.5)	0.626
≥ 3	4 (50.0)	3 (37.5)
HE grades
II	4 (50.0)	5 (62.5)	0.626
III-IV	4 (50.0)	3 (37.5)
Esophageal varix (%)	87.5	50.0	0.106
Albumin (g/dL), median (IQR)	3.15 (2.75-3.55)	3.10 (2.85-3.25)	0.635
Bilirubin (mg/dL), median (IQR)	2.88 (0.85-4.91)	2.51 (0.26-4.76)	0.345
Creatinine (mg/dL), median (IQR)	1.38 (0.17-2.59)	0.93 (0.48-1.38)	0.674
INR, median (IQR)	1.41 (1.22-1.60)	1.42 (1.12-1.72)	0.875
MELD × 10, median (IQR)	14.08 (7.57-20.59)	11.08 (5.32-16.84)	0.248
CTP score, median (IQR)	9.38 (8.08-10.68)	8.88 (7.33-10.43)	0.431

HBV: Hepatitis B virus; HE: Hepatic encephalopathy; IQR: Interquartile range; INR: International normalized ratio; MELD: Model for end-stage liver disease; CTP: Child-Turcotte-Pugh.

Table 2 Predicting mortality and recurrence in patients with hepatic encephalopathy: A Cox proportional hazards model analysis

Characteristic	Mortality			HE recurrence
	HR	95%CI	P value	HR	95%CI	P value
Group
Control group	-	-		-	-
Treatment group	0.30	0.06-1.49	0.139	0.09	0.01-0.75	0.026a
Age (years)	0.97	0.91-1.04	0.430	0.95	0.88-1.02	0.147
Sex
Female	-	-		-	-
Male	1.45	0.34-6.15	0.611	1.54	0.34-6.99	0.573
Number of HE episodes during the previous 3 months	0.00	0.00, infinity	0.999	0.98	0.34-2.89	0.978
HE grades
II	-	-		-	-
III/IV	0.77	0.18-3.24	0.721	2.86	0.55-15.0	0.213
Albumin	0.35	0.09-1.37	0.132	0.98	0.19-5.06	0.979
Total bilirubin	1.13	0.80-1.61	0.479	1.20	0.88-1.64	0.245
Creatinine	0.71	0.24-2.10	0.531	1.12	0.55-2.28	0.760
INR	3.07	0.15-61.8	0.464	0.92	0.03-25.3	0.961
MELD	0.99	0.32-3.08	0.991	1.19	0.39-3.67	0.758
CTP class
B	-	-		-	-
C	2.35	0.50-11.0	0.277	5.61	1.02-30.9	0.048a

^aP < 0.05.

HR: Hazard ratio; CI: Confidence interval; HE: Hepatic encephalopathy; INR: International normalized ratio; MELD: Model for end-stage liver disease; CTP: Child-Turcotte-Pugh.

Table 3 Plasma ammonia levels before and after shunt embolization of the treatment group

Subject number	Plasma ammonia level before embolization		Plasma ammonia level after embolization
	Date of measurement	Lab result (μmol/L)1	Date of measurement	Lab result (μmol/L)1
1	August 10, 2023	100	August 17, 2023	92
2	May 10, 2022	130	February 17, 2022	90
3	May 22, 2021	218	June 16, 2021	60
4	December 26, 2020	213	December 29, 2020	95
5	January 17, 2020	143	March 12, 2020	118
6	September 8, 2017	180	October 11, 2017	62
7	April 4, 2014	237	April 18, 2014	45
8	June 27, 2023	83	July 27, 2023	82
		Median (161.5)		Median (86)
		mean ± SD (163.0 ± 57.5)		mean ± SD (80.5 ± 23.5)

¹Reference range: 0-65 μmol/L.