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Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.

Publication ,  Journal Article
Helzberg, JH; Dai, R; Muir, AJ; Wilder, J; Lee, T-H; Martin, JG; Kim, CY; Ronald, J
Published in: J Vasc Interv Radiol
July 2021

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 creation, 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 creation, and mortality after TIPS creation, 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 creation. Ethnicity was not associated with the rate of HE after TIPS creation (IRR = 0.77, CI = 0.46-1.29; P = .28). In multivariable survival analysis, neither SES quartile nor ethnicity predicted mortality after creation of a TIPS. CONCLUSION: Lower SES is associated with higher rates of new or worsening HE after TIPS creation.

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Published In

J Vasc Interv Radiol

DOI

EISSN

1535-7732

Publication Date

July 2021

Volume

32

Issue

7

Start / End Page

950 / 960.e1

Location

United States

Related Subject Headings

  • United States
  • Social Class
  • Severity of Illness Index
  • Retrospective Studies
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Humans
  • Hepatic Encephalopathy
 

Citation

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Helzberg, J. H., Dai, R., Muir, A. J., Wilder, J., Lee, T.-H., Martin, J. G., … Ronald, J. (2021). Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol, 32(7), 950-960.e1. https://doi.org/10.1016/j.jvir.2020.11.022
Helzberg, James H., Rui Dai, Andrew J. Muir, Julius Wilder, Tzu-Hao Lee, Jonathan G. Martin, Charles Y. Kim, and James Ronald. “Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.J Vasc Interv Radiol 32, no. 7 (July 2021): 950-960.e1. https://doi.org/10.1016/j.jvir.2020.11.022.
Helzberg JH, Dai R, Muir AJ, Wilder J, Lee T-H, Martin JG, et al. Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol. 2021 Jul;32(7):950-960.e1.
Helzberg, James H., et al. “Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation.J Vasc Interv Radiol, vol. 32, no. 7, July 2021, pp. 950-960.e1. Pubmed, doi:10.1016/j.jvir.2020.11.022.
Helzberg JH, Dai R, Muir AJ, Wilder J, Lee T-H, Martin JG, Kim CY, Ronald J. Socioeconomic Status Is Associated with the Risk of Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol. 2021 Jul;32(7):950-960.e1.
Journal cover image

Published In

J Vasc Interv Radiol

DOI

EISSN

1535-7732

Publication Date

July 2021

Volume

32

Issue

7

Start / End Page

950 / 960.e1

Location

United States

Related Subject Headings

  • United States
  • Social Class
  • Severity of Illness Index
  • Retrospective Studies
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Humans
  • Hepatic Encephalopathy