Prediction of therapeutic effect by BRTO for the patients with portosystemic shunt hepatic encepharopathy

Abstract

Balloon occluded retrograde transvenous obliteration (BRTO) is effective for porto-systemic shunt hepatic encephalopathy (PSHE), although some patients have refractory to BRTO. We investigate the usefulness of BRTO for patients with PSHE. Nineteen patients with liver cirrhotic and PSHE were divided in two groups, group NE (recurred PSHE within 12 weeks after BRTO: n＝6) and group E (did not recur PSHE within 12 weeks: n＝13). We analyzed Child-Pugh score (CPS), serum ammonia (NH₃), hepatic venous pressure gradient (HVPG) and skeletal muscle index (SMI). In group NE, HVPG was higher and SMI was lower significantly than group E. The patients HVPG over 12 mmHg tended early recur of PSHE compared with less 12 mmHg. The diagnostic capability for predicting therapeutic effectiveness of HVPG and SMI were satisfactory with area under the receiver operating characteristic curve (AUROC) of 0.91 (p＜0.001, 95%CI＝0.77-1.04), 0.84 (p＜0.001, 95%CI＝0.65-1.03). HVPG and SMI before BRTO might be useful factor for prediction of therapeutic effect.