Development and validation of a psoas muscle thickness-based prediction model for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

BACKGROUND Overt hepatic encephalopathy (OHE) occurs in 20%-50% of patients following transjugular intrahepatic portosystemic shunt (TIPS), and the existing predictive models lack objective nutritional parameters.AIM To develop and validate a novel prediction tool incorporating computed tomographyderived psoas muscle thickness-to-height ratio (PMTH/H).METHODS We retrospectively enrolled 606 patients with cirrhosis undergoing their first TIPS at four Chinese centers (September 2017 to September 2023), all without previous OHE.Center I patients were stratified by OHE status and randomly allocated in a 7:3 ratio to the training (n = 303) and internal validation (n = 131) cohorts.Centers II-IV formed the pooled external validation cohort (n = 172).The primary outcome was 12-month post-TIPS OHE.A nomogram and the age-bilirubin-creatinine-psoas muscle thickness (APTC) scores were developed from independent predictors.RESULTS Age, history of diabetes mellitus, total bilirubin, serum creatinine, and PMTH/H were identified as independent predictors of OHE.The APTC score yielded time-dependent areas under the curve of 0.836 (95%CI: 0.787-0.885),0.764 (0.672-0.856), and 0.850 (0.789-0.910) in the training, internal validation, and external validation cohorts, respectively.The corresponding concordance index values were 0.790 (0.745-0.835), 0.722 (0.647-0.797), and 0.784 (0.727-0.840).Compared with the Freiburg Index of Post-TIPS Survival, Model for End-Stage Liver Disease, Child-Pugh, and Modified TIPS Score, the APTC score achieved integrated discrimination improvement values of 14.7%, 24.5%, 26.2%, and 19.8%, respectively, in the overall cohort (all P < 0.001).CONCLUSION Incorporating PMTH/H, the APTC score accurately predicts 12-month OHE in patients undergoing their first TIPS without previous OHE, pending prospective validation.