Author information

• ¹Department of Medicine, Duke University School of Medicine, Durham.
• ²Duke University School of Medicine, Durham.
• ³Department of Medicine, Duke University School of Medicine, Durham; Duke Clinical Research Institute, Duke University School of Medicine, Durham.
• ⁴Division of Vascular and Interventional Radiology, Department of Radiology, Duke University School of Medicine, Durham.
• ⁵Division of Vascular and Interventional Radiology, Department of Radiology, Duke University School of Medicine, Durham. Electronic address: james.ronald@duke.edu.

Abstract

Purpose: To determine whether socioeconomic status (SES) is associated with hepatic encephalopathy (HE) risk after transjugular intrahepatic portosystemic shunt (TIPS) creation.

Materials and methods: This single-institution retrospective study included 368 patients (mean age = 56.7 years; n = 229 males) from 5 states who underwent TIPS creation. SES was estimated using the Agency for Healthcare Research and Quality SES index, a metric based on neighborhood housing, education, and income statistics. Episodes of new or worsening HE after TIPS, defined as hospitalization for HE or escalation in outpatient medical therapy, were identified from medical records. Multivariable ordinal regression, negative binomial regression, and competing risks survival analysis were used to identify factors associated with SES quartile, the number of episodes of new or worsening HE per unit time after TIPS, and mortality after TIPS, respectively.

Results: There were 83, 113, 99, and 73 patients in the lowest, second, third, and highest SES quartiles, respectively. In multivariable regression, only older age (β = 0.04, confidence interval [CI] = 0.02-0.05; P < .001) and white non-Hispanic ethnicity (β = 0.64, CI = 0.07-1.21; P = .03) were associated with higher SES quartile. In multivariable regression, lower SES quartile (incidence rate ratio [IRR] = 0.80, CI = 0.68-0.94; P = .004), along with older age, male sex, higher model for end-stage liver disease score, nonalcoholic steatohepatitis, and proton pump inhibitor use were associated with higher rates of HE after TIPS. Ethnicity was not associated with the rate of HE after TIPS (IRR = 0.77, CI = 0.46-1.29; P = .28). In multivariable survival analysis, neither SES quartile nor ethnicity predicted mortality after TIPS.

Conclusion: Lower SES is associated with higher rates of new or worsening HE after TIPS creation.