Animal naming test at discharge is associated with hepatic encephalopathy after elective TIPS

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Backgrounds and aims Overt hepatic encephalopathy (OHE) is the most feared complication after transjugular intrahepatic portosystemic shunt (TIPS) placement. We aimed to evaluate the usefulness of the animal naming test (ANT) in predicting the occurrence of OHE after elective TIPS placement. Methods The ANT (1 min) was evaluated before TIPS, at discharge, and at 1, 3, and 6 months in all patients treated with elective TIPS between September 2019 and November 2024. Results We included 100 consecutive patients (80% men, age 59 years, median MELD score 11, indication for TIPS for ascites/ secondary prophylaxis/ hydrothorax/pre-surgery in 63/19/5/13%, history of OHE in 24%). The median ANT before TIPS was 21 (IQR 17 – 27). Overall, the cumulative incidence of OHE was 30%, considering death and liver transplantation as competing events. In multivariate analysis, independent factors associated with the subsequent development of OHE were age (HR = 1.04, 95% CI [1.00-1.09], p=0.02), pre-TIPS ammonia level (HR=1.01, 95% CI [1.00-1.03], p=0.02), ammonia level at discharge (HR=1.01, 95% CI [1.01-1.03], p=0.04), and ANT at discharge (HR=0.89, 95% CI [0.81-0.97], p=0.005), but not ANT before TIPS. After discharge, the predictive value of ANT was stable for the diagnosis of subsequent OHE. Conclusion Animal naming test at discharge may be useful in identifying patients at higher risk of overt hepatic encephalopathy after TIPS. Impact and implications ANT before TIPS is not accurate for the prediction of further development of OHE.In the current student, both ANT and ammonia after TIPS were predictive of OHE.Each decrease of ANT of 1 point was associated with an increased risk of OHE of 8%.

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