Diabetes Mellitus is a Risk Factor for Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt
Bibliographic record
Abstract
OBJECTIVES: Transjugular intrahepatic portosystemic shunt (TIPS) placement effectively decreases portal pressure in patients with decompensated cirrhosis. However, many patients develop hepatic encephalopathy (HE) post-TIPS. We investigated the relation between the presence of Diabetes Mellitus (DM) and the occurrence of HE following TIPS placement in patients with cirrhosis. METHODS: In this retrospective cohort study all patients with cirrhosis who received a TIPS from 2007 through 2021 were included. Baseline characteristics and decompensating events including hospital admission for HE were recorded. In cases where hospital admission was required, HE was considered severe. RESULTS: In total, 325 patients were included and 113 (34.8%) had DM at the time of TIPS placement. One hundred and fifty-one patients developed HE of whom 86 (57.0%) were hospitalised. The cumulative 6-month incidences of HE and severe HE were 45.2% (95% CI 39.5-51.8) and 25.1% (95% CI 20.2-31.3), respectively. Multivariable Cox regression with competing risk analyses demonstrated that DM was independently associated with the risk of both HE (aHR 1.56, 95% CI 1.08-2.26, p = 0.018) and severe HE (aHR 1.76, 95% CI 1.07-2.90, p = 0.026). These associations were independent of the relation between HE and age (aHR 1.03, 95% CI 1.01-1.05, p < 0.001) or MELD-Na score (aHR 1.07, 95% CI 1.03-1.10, p < 0.001). CONCLUSIONS: This study highlights the high incidence of HE following TIPS and shows that DM is a significant and independent risk factor for the development of HE. Given the increase in patients with metabolic dysfunction-associated liver cirrhosis and DM, this study offers additional insights into the balance of risks and benefits associated with TIPS placement.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".