Triglyceride Glucose Index predicts the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Triglyceride Glucose Index predicts the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Triglyceride Glucose Index predicts the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt Chengzhi Bai, Lanjing Wang, Yalun Chen, Dong Mu, Shumei Zheng, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7008044/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Hepatic encephalopathy (HE) represents a frequent and clinically significant complication following transjugular intrahepatic portosystemic shunt (TIPS) placement, profoundly affecting both patient quality of life and long-term prognosis. Early assessment and timely identification of potential post-TIPS HE are critically important for improving clinical outcomes. Methods Cirrhotic patients undergone TIPS were retrospectively enrolled from January 2018 to November 2021 in this study. Demographic information and clinical materials were retrospectively collected. Based on the occurrence of overt hepatic encephalopathy (OHE) postoperatively, patients were stratified into no-OHE and OHE groups. Univariate and multivariate logistic regression were performed to identify predictors of post-TIPS OHEs. And a nomogram was developed using independent risk factors. ROC curve analysis was plotted to assess the predictive ability of the triglyceride glucose (TyG) index. Calibration plots and Decision curve analysis (DCA) was used to evaluate the model's fit and predictive benefits. Results A total of 146 patients were retrospectively enrolled in this study, of which 67 suffered from OHE. Compared with the no-OHE group, TyG index was significantly higher in the OHE group (8.748 (8.289,9.128) vs 8.107 (7.724,8.395), P < 0.001). Multivariate logistic regression analysis showed that TyG index, neutrophil count, and SBP incidence were independent risk factors for post-TIPS OHE (OR 9.655, 95% CI 3.957–23.555 P = 0.001; OR 1.272, 95% CI 1.000–1.656 P = 0.05; OR 0.212, 95% CI 0.061–0.736 P = 0.015, respectively). Then a nomogram model for the incidence of OHE was constructed and the ROC curve of the new model was plotted with the AUC of the new model 0.704, indicating a good predictive performance. Calibration plots and Decision curve analysis (DCA) also showed the model had good fit. Conclusions TyG index serves as an independent predictor and may represent a novel prognostic biomarker for predicting post-TIPS HE. Transjugular intrahepatic portosystemic shunt Hepatic encephalopathy Triglyceride glucose index Risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction In decompensated cirrhosis, portal hypertension drives severe clinical complications including acute variceal bleeding and refractory ascites, profoundly compromising patient quality of life and survival outcomes [ 1 ]. The transjugular intrahepatic portosystemic shunt (TIPS) procedure creates a direct communication between the portal and hepatic venous systems, diverting splanchnic blood into the systemic circulation. This hemodynamic modification achieves effective portal decompression, thereby controlling major complications of portal hypertension including variceal hemorrhage and refractory ascites [ 2 ]. Hepatic encephalopathy (HE) is a frequent and clinically significant complication following TIPS, often occurring within three months post-operation. It has been reported the incidence of HE after TIPS varies substantially 10–50% among cirrhotic patients [ 3 , 4 ]. Overt-hepatic encephalopathy (OHE) correlates with poor clinical outcomes including impaired quality of life, recurrent hospitalizations, and higher mortality. Furthermore, the mortality risk dramatically pronounced in patients with grade II-IV HE, compared to grade 0 HE patients [ 5 ]. This adverse effect remains a key limiting factor in the broader clinical adoption of TIPS. Therefore, identification risk factors for OHE after TIPS is of significant clinical importance. Previous studies have identified several risk factors, including older age, higher Child-Pugh score, history of HE and lower serum sodium, as predictors of poor outcomes in patients with decompensated cirrhosis undergoing TIPS [ 6 , 7 ]. However, the current landscape lacks both well-validated biomarkers and effective clinical tools specifically for post-TIPS HE. This underscores the critical need to develop more precise risk stratification methods and personalized treatment approaches for this patient population, which would empower clinicians to implement early therapeutic interventions for high-risk patient cohorts. Insulin resistance (IR) is a hallmark of metabolic dysfunction and systemic inflammation. The triglyceride glucose (TyG) index was first introduced by professor Unger as a surrogate marker of IR [ 8 ]. Extensive research has demonstrated the TyG index's strong association with acute pancreatitis, carotid atherosclerosis, myocardial infarction and some tumors [ 9 – 12 ]. Moreover, an elevated TyG index was significantly linked with a poor prognosis of ischemic stroke [ 13 ]. Despite these established relationships, evidence regarding the TyG index's prognostic value in patients with decompensated liver cirrhosis undergoing TIPS remains limited. To address this knowledge gap, we performed a retrospective cohort study to evaluate the association between TyG index and the incidence of OHE after TIPS in decompensate cirrhosis patients. Patients and methods Study population This study conducted a retrospective analysis of cirrhotic patients who underwent TIPS in the Department of Gastroenterology of the General Hospital of Western Theater Command from January 2018 to January 2021. The indications for TIPS included uncontrollable or recurrent gastrointestinal variceal bleeding and refractory ascites, which were diagnosed by clinical manifestations, laboratory tests, endoscopy and imaging examinations. Exclusion criteria: (1) patients with previous HE before TIPS; (2) patients with history of splenectomy or splenic artery embolization; (3) patients who had undergone partial hepatectomy; (4) patients with other extrhepatic malignant tumors or acute severe conditions expected to shorten life expectancy to less than 6 months; (5) patients with incomplete clinical information; (4) Patients who died or were lost to follow-up within 12 months after TIPS. All patients were informed of the benefits, risks and complications associated with the TIPS surgery, and received written informed consent. Finally, 58 patients were excluded, and a total of 146 patients were included in this study (Fig. 1 ). The study protocol was approved by the Ethical Committee of The General Hospital of Western Theater Command (Approval No. 2023EC5-ky058), and was conducted in accordance with the ethical principles of the Declaration of Helsinki. TIPS procedure The TIPS procedure has been described in detail before and all procedures were performed by the same experienced gastroenterologist [ 14 ]. All procedures were performed under local anesthesia. An 8-mm VIATORR self-expanding polytetrafluoroethylene-covered stent (Gore and Associates, United States) were implanted between the hepatic vein and portal vein. After TIPS creation, portal venography was performed to detect esophageal-gastric varices, and the varices were embolized once found. Data collection and follow-up Patients were followed up at 1, 3, and 6 months postoperatively to monitor hepatic encephalopathy (HE) and survival rates. Demographic, clinical details and the parameters for TIPS procedure were gathered systematically during the patients’ first admission. Patients were followed for the development of overt HE (OHE) and liver transplantation/death after TIPS insertion. According to the American Association for the Study of Liver Diseases (AASLD) guidelines [ 15 ], OHE was defined as West-Haven grade II-IV. Based on the occurrence of OHE during follow-up, patients were divided into an OHE group and a no-OHE group. The TyG index was calculated using the following formula: TyG = ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] [ 16 ]. Statistical analysis Statistical analysis was conducted using SPSS 25.0. Quantitative data that followed a normal distribution were expressed as mean ± standard deviation (SD), and comparisons between the two were performed using the paired t -test; quantitative data that did not follow a normal distribution were expressed as M (P25 - P75), and comparisons between the two groups were conducted using the Mann-Whitney U test. Comparisons of qualitative data between the two groups were performed using the Chi-square or Fisher’s exact test. A P value < 0.05 indicated statistically significant differences. Binary Logistic regression analysis was used to determine the independent influencing factors for the occurrence of HE after TIPS surgery. The R 4.2.2 software was used to construct a risk prediction nomogram model for HE occurrence in patients after TIPS. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of the model for HE occurrence in patients after TIPS. Calibration curves and decision curves of the constructed model were drawn to assess the model's fit and predictive benefits. Results Baseline Characteristics of the Study Population A total of 146 patients who received TIPS treatment were hospitalized in the Department of Gastroenterology of the General Hospital of Western Theater Command and collected in this study. The patients were divided into the no-OHE group (79 cases) and OHE group (67 cases) based on the occurrence of OHE. Of the 146 patients, 56 (38.3%) were female and 90 (61.7%) were male, the mean age was 55 years, and the etiology was mostly hepatitis B cirrhosis (56.2%). The TyG index levels were 8.107 (7.724,8.395) in the no-OHE group and 8.748 (8.289,9.128) in OHE group, respectively ( P < 0.001). The incidence of spontaneous peritonitis (SBP), diabetes, neutrophil count, monocyte count, blood glucose, triglycerides, and TyG index in the OHE group were significantly higher than those in the no-OHE group (Table 1 ). Table 1 Baseline Characteristics of the patients Variables All patients(n = 146) No-OHE group(n = 79) OHE group(n = 67) Statistic P value Age, years 55 (47,63) 52 (45,62.5) 60.5 (50.75,66.25) Z = 1.849 0.064 Male (%) 90 (0.616) 49 (0.620) 41 (0.612) χ2 = 0.11 0.918 Etiology Hepatitis B 82 (0.562) 45(0.570) 37(0.552) χ 2 = 0.450 0.930 Alcohol 15 (0.103) 8(0.101) 7(0.104) Autoimmunity 19 (0.130) 9(0.114) 10(0.149) Other 30 (0.205) 17(0.215) 13(0.194) SBP (%) 18 (0.123) 6 (0.076) 12 (0.179) χ2 = 3.850 0.050 Diabetes (%) 18 (0.123) 5 (0.063) 13 (0.194) χ2 = 5.733 0.017 AFP, ng/mL 3.632 ± 3.291 3.234 ± 1.936 3.878 ± 2.777 t=-1.085 0.200 Albumin, g/L 35.1 (31.5,38.7) 35.9 (33.265,39.25) 34.05 (30.075,38.15) Z=-1.591 0.112 Prealbumin, mg/L 102.22 (80,127.8) 107 (84.7,137.95) 94.24 (73.625,119.75) Z=-1.382 0.167 TBIL, µmmol/L 30.427 ± 21.264 28.54 ± 22.505 30.987 ± 17.176 t = 0.238 0.705 ALT, U/L 31.696 ± 45.79 25.765 ± 20.709 30.304 ± 42.38 t=-0.261 0.935 AST, U/L 39.817 ± 33.951 35.037 ± 25.951 40.602 ± 44.152 t=-1.666 0.211 GGT, U/L 64.955 ± 108.959 57.082 ± 97.486 61.983 ± 60.377 t=-1.474 0.067 ALP, U/L 107.324 ± 76.787 99.614 ± 69.139 104.313 ± 51.495 t=-2.006 0.053 TBA, umol/L 24.918 ± 28.624 22.703 ± 22.116 23.002 ± 21.207 t=-1.018 0.195 INR 1.200 ± 0.152 1.191 ± 0.149 1.207 ± 0.17 t = 0.933 0.798 PT, seconds 13.678 ± 1.701 13.526 ± 1.622 13.737 ± 1.937 t = 0.737 0.648 Hemoglobin, g/L 83 (71,97) 81 (68.5,95.5) 84 (70.5,103.25) Z = 0.581 0.561 RBC, ×10 12 /L 2.95 (2.58,3.4) 2.980 (2.695,3.400) 2.915 (2.5,3.403) Z=-0.642 0.521 WBC, ×10 9 /L 3.676 ± 2.773 3.193 ± 1.663 4.587 ± 4.19 t=-2.468 0.043 Platelet, ×10 9 /L 71.24 ± 56.932 75.880 ± 69.222 70.170 ± 51.180 t = 0.114 0.160 Neutrophil, ×10 9 /L 2.585 ± 2.252 2.206 ± 1.209 3.308 ± 3.387 t=-2.288 0.050 Lymphocyte, ×10 9 /L 0.705 ± 0.497 0.708 ± 0.512 0.751 ± 0.615 t=-0.703 0.481 Monocyte, ×10 9 /L 0.307 ± 0.276 0.26 ± 0.191 0.395 ± 0.408 t=-2.716 0.003 TC, mmol/L 2.95 (2.4,3.83) 2.95 (2.455,3.59) 2.895 (2.215,3.903) Z = 1.734 0.083 TG, mmol/L 0.83 (0.63,1.03) 0.71 (0.545,0.905) 0.97 (0.768,1.315) Z = 5.134 <0.001 HDL, mmol/L 1.01 (0.76,1.33) 1.02 (0.845,1.335) 0.95 (0.668,1.245) Z=-0.012 0.991 LDL, mmol/L 1.61 (1.24,2.07) 1.55 (1.195,2.02) 1.67 (1.248,2.128) Z = 1.962 0.050 FBG mmol/L 6.45 (5.17,8.04) 5.8 (4.885,7.01) 7.14 (5.83,10.66) Z = 4.288 <0.001 TyG 8.336 (7.956,8.755) 8.107 (7.724,8.395) 8.748 (8.289,9.128) Z = 6.176 <0.001 Urea, mmol/L 281 (220.8,348) 274 (207.6,329.7) 281.5 (225.45,357.75) Z = 1.213 0.225 SCr, ummol/L 3.931 ± 23.942 74.789 ± 20.712 76.102 ± 31.743 t = 0.267 0.131 MELD 9.476 (7.599,12.003) 8.836 (7.004,11.929) 9.777 (7.903,12.316) Z = 0.907 0.364 Data presented as mean ± SD or number of patients (%) where appropriate. SBP, spontaneous peritonitis; AFP, alpha-fetoprotein; TBIL, Total bilirubin; ALT, alanine aminotransferase; AST aspartate aminotransferase; GGT, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; TBA, total bile acid; INR international normalized ratio; PT prothrombin time; RBC, red blood cell; WBC, white blood cell; TC, total cholesterol; TG, Triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; FBG, fasting blood glucose; TyG, triglyceride glucose index; SCr, serum creatinine; MELD, model for end-stage liver disease. Analysis of the predictive value of TyG index for the incidence of HE in patients after TIPS The inter-group analysis showed that the TyG index, TG, and FBG all had statistical significance between the two groups. To clarify the predictive value of these three indicators for the occurrence of HE after TIPS, a single-factor analysis of TyG index, TG, and FBG was conducted using the logistic regression model. The results indicated that all three indicators were risk factors for the occurrence of HE after TIPS in patients, and the TyG index had a more significant statistical significance (Table 2 ). Analysis of risk factors for the incidence of hepatic encephalopathy after TIPS Based on the above research results, a single-factor analysis was conducted on the TyG index and baseline indicators. The indicators that were significant in the single-factor analysis (TyG index, white blood cell count, monocyte count, neutrophil count, diabetes incidence, SBP incidence) were then analyzed using the forward likelihood method of multivariate Logistic regression (Table 3 ). The results showed that the TyG index, neutrophil count, and SBP incidence were independent influencing factors for the occurrence of HE in patients after TIPS ( p < 0.05). Table 3 Logistic regression analysis of HE occurrence in patients after TIPS surgery Variables Univariate analysis OR (95% CI) P value Multivariate analysis OR (95% CI) P value Age, years 1.026(0.997,1.055) 0.078 Male (%) 0.965(0.494,1.885) 0.918 AFP, ng/mL 1.060(0.951,1.181) 0.291 Albumin, g/L 0.956(0.890,1.026) 0.214 Prealbumin, mg/L 0.996(0.988,1.004) 0.338 TBIL, µmmol/L 0.998(0.983,1.014) 0.811 ALT, U/L 1.001(0.994,1.008) 0.794 AST, U/L 1.010(0.997,1.023) 0.128 GGT, U/L 1.003(0.999,1.006) 0.180 ALP, U/L 1.005(1.000,1.011) 0.072 TBA, umol/L 1.006(0.994,1.019) 0.323 INR 0.353(0.040,3.137) 0.350 PT, seconds 0.929(0.764,1.129) 0.459 Hemoglobin, g/L 1.003(0.987,1.019) 0.701 RBC, ×10 12 /L 0.897(0.561,1.435) 0.651 WBC, ×10 9 /L 1.228(1.023,1.472) 0.027 Platelet, ×10 9 /L 1.000(0.994,1.005) 0.909 Neutrophil, ×10 9 /L 1.287(1.015,1.633) 0.038 1.272(1.000,1.656) 0.05 Lymphocyte, ×10 9 /L 1.268(0.654,2.457) 0.482 Monocyte, ×10 9 /L 8.354(1.509,46.257) 0.015 TC, mmol/L 1.358(0.979,1.885) 0.067 HDL, mmol/L 0.972(0.480,1.968) 0.938 LDL, mmol/L 1.124(0.767,1.647) 0.549 TyG 9.103(3.918,21.149) <0.001 9.655(3.957,23.555) 0.001 Urea, mmol/L 0.998(0.984,1.012) 0.788 SCr, ummol/L 1.002(0.999,1.005) 0.231 SBP 0.363(0.128,0.999) 0.050 0.212(0.061,0.736) 0.015 Diabetes 0.281(0.094,0.834) 0.022 Data presented as mean ± SD or number of patients (%) where appropriate. SBP, spontaneous peritonitis; AFP, alpha-fetoprotein; TBIL, Total bilirubin; ALT, alanine aminotransferase; AST aspartate aminotransferase; GGT, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; TBA, total bile acid; INR international normalized ratio; PT prothrombin time; RBC, red blood cell; WBC, white blood cell; TC, total cholesterol; TG, Triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; FBG, fasting blood glucose; TyG, triglyceride glucose index; SCr, serum creatinine. Construction and efficacy verification of nomogram model for predicting the incidence of HE after TIPS Based on the above Logistic regression analysis results, a nomogram model for the incidence of HE in patients after TIPS was constructed and plotted using R language. The corresponding scores were calculated according to the levels of each factor in the nomogram model, and the total score was obtained by summing up the corresponding scores. A vertical line was drawn from the total score to the risk assessment axis below the prediction model, and the value at the intersection point was the risk of HE in patients after TIPS (Fig. 2 ). The ROC curve of the new model was plotted, and the AUC of the new model was 0.704, indicating that the new model had good predictive performance (Fig. 3 ). The calibration curve and decision curve (DCA) of the new model were plotted using R language, and the results indicated that the model had good fit (Fig. 4 ), and the decisions made through this model could bring net benefits (Fig. 5 ). Discussion In this retrospective study, we established for the first time that elevated TyG index significantly correlates with increased risks of OHE in decompensate cirrhosis patients after TIPS. Moreover, our findings introduce the TyG index as a practical, readily available tool for risk prediction for OHE occurrence in these patients. Given the substantial incidence of post-TIPS HE, early detection and preventive interventions are critical for optimizing both quality of life and long-term clinical outcomes in cirrhosis patients. Current prognostic scoring systems for post-TIPS HE are complicated, time-consuming and have limited efficacy. For example, although the Child-Pugh classification has been associated with HE risks prediction [ 17 ], its reliance on subjective elements (notably HE assessment) compromises scoring reproducibility and thus clinical reliability. These limitations underscore the urgent need to develop convenient, non-invasive biomarkers capable of reliably identifying post-TIPS HE high-risk groups at early stages. IR is characterized by impaired cellular glucose uptake and utilization. Substantial evidence demonstrates that IR contributes to cardiovascular risk across diverse populations through multiple pathological mechanisms: (1) disruption of glucose and lipid homeostasis, (2) induction of oxidative stress and chronic inflammation, (3) endothelial dysfunction, and (4) ectopic lipid deposition [ 18 – 20 ]. The TyG index is a readily straightforward marker of IR, and numerous studies have shown a significant association between TyG and metabolic disorder-related diseases such as diabetes, obesity, and cardiovascular disease. For liver cirrhosis, there are also abnormal metabolic disorders. While, few studies focused on the TyG and HE occurrence after TIPS. In our study, logistic regression demonstrated that the TyG index, neutrophil count, and SBP incidence were independent influencing factors for the occurrence of OHE in patients after TIPS. Further, the nomogram model based on TyG also showed good predictive performance (AUC 0.704). In a retrospective study, the predictive efficacy of the Child-Pugh and MELD for post-TIPS HE was AUC = 0.596 and AUC = 0.641, respectively [ 7 ]. Compared with this research, our model exhibits superior predictive performance. These results indicate that TyG index could effectively identify patients at high risk of OHE after TIPS, offering a valuable tool for preoperative risk assessment. The index reflects disturbances in glucose and lipid metabolism, which are critical factors in post-TIPS HE. And previous studies have shown that diabetes was an independent risk factors for OHE in patients after TIPS and patients with diabetes have a high risk of developing OHE [ 21 , 22 ]. Additionally, hyperglycemia has been proven to induce oxidative stress through mitochondrial or endoplasmic reticulum dysfunction, systemic inflammation and microvascular endothelial impairment [ 23 – 25 ]. These metabolic disturbances collectively promote a pro-inflammatory and pro-coagulant state characterized by upregulated inflammatory mediators, enhanced apoptotic activity-all of which facilitates the systemic accumulation of neurotoxic substances, enabling their unrestricted passage across the blood-brain barrier and subsequent triggering of HE. Previous studies demonstrated a higher TyG index was correlated with increased visceral obesity in gastric cancer patients [ 26 ]. Notably, visceral fat area index has been found as a good indicator of HE in cirrhotic patients after TIPS [ 27 ]. And patients with low visceral fat area had a higher risk of post-TIPS HE. Therefore, based on our results, we believe that the TyG index could potentially serve as a simple and cost-effective alternative to visceral fat area to predict the occurrence of HE. In addition, prophylactic treatment including use of small-diameter stents and oral administration lactulose or rifaximin in patients with high TyG index levels is an interesting and potentially valuable approach to reduce the risk of HE after TIPS. This study has several limitations that should be acknowledged. First, the retrospective design precluded assessment of TyG dynamic changes during follow-up. Second, while we adjusted for multiple confounders, potential residual confounding may be inevitable due to the single-center nature and modest sample size of our cohort. Finally, the cutoff value of TyG is derived from our own patient cohort and requires validation in multicenter populations to confirm its predictive utility. These limitations highlight the need for prospective, multicenter studies with comprehensive metabolic profiling to validate our findings and elucidate the TyG index's clinical utility in HE management. In conclusion, our findings establish the TyG index as a robust predictor of HE in patients after TIPS. These results position the TyG index as a clinically accessible tool for risk stratification in decompensate cirrhosis patients after TIPS, offering valuable prognostic information beyond conventional assessments. Declarations Acknowledgements Not Applicable. Author contributions Chengzhi Bai, Lanjing Wang, Jianping Qin and Liang Zhang designed the study and drafted the manuscript. Yalun Chen, Dong Mu, Shumei Zheng and Shanhong Tang collected the clinical data. Liang Zhang and Jianping Qin reviewed the data and revised the manuscript. All authors approved the final version. Funding No funding Data availability The data are available from the corresponding authors on reasonable request. Ethics approval and consent to participate The study was performed according to the ethical guidelines of the Declaration of Helsinki and was approved and the need for consent to participate was waived by the Ethical Committee of The General Hospital of Western Theater Command, with the need for consent to participate waived (2023EC5-ky058). Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Elliot B T, Neehar D P. Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA. 2023, 329(18): 1589-1602. Justin R B, Bartley G T, Sumeet K A, Michael B F, Brett E F, Manhal J I, et al. North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension. Clin Gastroenterol Hepatol. 2021, 20(8) :1636-1662.e36. Philipp S, Hauke H, Jonel T, Moritz W. Shunt-Induced Hepatic Encephalopathy in TIPS: Current Approaches and Clinical Challenges. 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Diabetes mellitus increases the risk of hepatic encephalopathy after a transjugular intrahepatic portosystemic shunt in cirrhotic patients. Eur J Gastroenterol Hepatol. 2019, 31(10):1264-1269. Huan C, Zihao C, Binlin D, Chunxiang W, Qin Y, Jiangqiang X, et al. Analysis of independent risk factors for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with cirrhosis combined with diabetes. Eur J Gastroenterol Hepatol. 2024, 37(2):214-218. Teresa Vanessa F, Annamaria P, Pengou Z, Franco F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Curr Pharm Des. 2013, 19(32):5695-703. Shenping L, Junjie D, Dandan S, Shimei C, Xieyi Y, Ning W, et al. FBXW7 alleviates hyperglycemia-induced endothelial oxidative stress injury via ROS and PARP inhibition. Redox Biol. 2022, 58:102530. Xiaogang S, Chongxi F, Chao W, Wuhan Y, Jichao T, Feng M, et al. Mitochondria fission accentuates oxidative stress in hyperglycemia-induced H9c2 cardiomyoblasts in vitro by regulating fatty acid oxidation. Cell Biol Int. 2024, 48(9):1378-1391. Junbo Z, Zhenhua H, Yan G, Xin D, Xiuhua W, Yan H. Triglyceride-glucose index as a marker for visceral obesity in patients with gastric cancer. Front Nutr. 2025, 11:1515918. Chuhan W, Yue T, Jin G, Zichen Z, Yonggang L. Low adipose tissue index as an indicator of hepatic encephalopathy in cirrhotic patients following transjugular intrahepatic portosystemic shunt. Abdom Radiol (NY). 2023, 48(4):1454-1467. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 28 Jul, 2025 Editor invited by journal 01 Jul, 2025 Editor assigned by journal 01 Jul, 2025 Submission checks completed at journal 01 Jul, 2025 First submitted to journal 30 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7008044","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492478210,"identity":"a3e84740-b694-4292-b438-60aa8e6affb9","order_by":0,"name":"Chengzhi Bai","email":"","orcid":"","institution":"The General Hospital of Western Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Chengzhi","middleName":"","lastName":"Bai","suffix":""},{"id":492478211,"identity":"0bbd1390-b84e-4551-b0b1-7a5ca70ca55e","order_by":1,"name":"Lanjing Wang","email":"","orcid":"","institution":"Shifang People’s Hospital, North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Lanjing","middleName":"","lastName":"Wang","suffix":""},{"id":492478212,"identity":"dde96945-a31f-40b4-b024-17157458624d","order_by":2,"name":"Yalun Chen","email":"","orcid":"","institution":"The General Hospital of Western Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Yalun","middleName":"","lastName":"Chen","suffix":""},{"id":492478213,"identity":"0fa20c8d-88a7-4f02-80c1-28f249745bb1","order_by":3,"name":"Dong Mu","email":"","orcid":"","institution":"The General Hospital of Western Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Mu","suffix":""},{"id":492478214,"identity":"bb6991bf-a722-4f9e-86af-3bba0b8703ff","order_by":4,"name":"Shumei Zheng","email":"","orcid":"","institution":"The General Hospital of Western Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Shumei","middleName":"","lastName":"Zheng","suffix":""},{"id":492478215,"identity":"372d25a7-4ec7-4a47-a2b4-80dd46d79c73","order_by":5,"name":"Shanhong Tang","email":"","orcid":"","institution":"The General Hospital of Western Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Shanhong","middleName":"","lastName":"Tang","suffix":""},{"id":492478216,"identity":"12dab796-fb0f-4ae9-b9b0-fe9eee077f01","order_by":6,"name":"Jianping Qin","email":"","orcid":"","institution":"The General Hospital of Western Theater Command","correspondingAuthor":false,"prefix":"","firstName":"Jianping","middleName":"","lastName":"Qin","suffix":""},{"id":492478217,"identity":"955e9c7f-24d2-4057-9d64-3f80ccb62221","order_by":7,"name":"Liang Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBACPmYwdQAuIMfG3n4Au1ooYEPSwtgAJIz5eM4k4NfCgKYlcZ6EgwF+LezMzx5++XNH3px/AfujmzmH09skGBIYflRsw+MwNnNjGZ5nhjtnPGBszt12OLdNuvEAY8+Z2/j8YiYtIXGYccONA1AtMgcSmBnb8Glh/yYtYXDYHqYlnU0iwYCAFh4zyQ8JhxM3nG8Aa0kgRkuZNMOBw8kbbjAwzs7dlm7YBgzkg/j8ws9/fJvkjz+HbTecP8DwOXebtbx8e/vBBz8qcGsBAWYeECmR/wEucgCveiBg/AG2j6C6UTAKRsEoGKkAAJ/AWUlkT6TqAAAAAElFTkSuQmCC","orcid":"","institution":"The General Hospital of Western Theater Command","correspondingAuthor":true,"prefix":"","firstName":"Liang","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-06-30 08:23:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7008044/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7008044/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88094624,"identity":"19374c35-d53c-454a-9538-cab70fdb2528","added_by":"auto","created_at":"2025-08-01 10:49:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":310322,"visible":true,"origin":"","legend":"\u003cp\u003eStudy design and flowchart. HE, hepatic encephalopathy\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7008044/v1/60f3eca4066a2e8aa28c0ed4.png"},{"id":88094615,"identity":"395558b9-c315-4370-a30a-3c60a81fb508","added_by":"auto","created_at":"2025-08-01 10:49:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":11804,"visible":true,"origin":"","legend":"\u003cp\u003eNomogram model of the probability of HE occurrence in patients after TIPS surgery.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7008044/v1/3c73b1465b1ef3e1edb9f40a.png"},{"id":88096546,"identity":"16e37ec9-2b98-451a-9b5b-cf10b1c21abb","added_by":"auto","created_at":"2025-08-01 10:57:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":176162,"visible":true,"origin":"","legend":"\u003cp\u003eThe ROC curve of the new model\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7008044/v1/a8cecad126c5ed9ae68d757e.png"},{"id":88097562,"identity":"d03ed7f1-4647-4b2b-b9d2-3db3163a2375","added_by":"auto","created_at":"2025-08-01 11:05:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":202908,"visible":true,"origin":"","legend":"\u003cp\u003eThe calibration curve of the new model.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7008044/v1/3b564153ee193a24832cd03a.png"},{"id":88094628,"identity":"22fed547-728f-4ade-947c-53afb30f888b","added_by":"auto","created_at":"2025-08-01 10:49:02","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":85276,"visible":true,"origin":"","legend":"\u003cp\u003eThe DCA curve of the new model.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7008044/v1/afad5b5cf61ce3f28472b416.png"},{"id":88100163,"identity":"780a70bf-a687-4d4d-8138-c4bdd9244007","added_by":"auto","created_at":"2025-08-01 11:21:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1736253,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7008044/v1/29af3ad2-2551-4cd1-9c95-448ca97dcd20.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Triglyceride Glucose Index predicts the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn decompensated cirrhosis, portal hypertension drives severe clinical complications including acute variceal bleeding and refractory ascites, profoundly compromising patient quality of life and survival outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The transjugular intrahepatic portosystemic shunt (TIPS) procedure creates a direct communication between the portal and hepatic venous systems, diverting splanchnic blood into the systemic circulation. This hemodynamic modification achieves effective portal decompression, thereby controlling major complications of portal hypertension including variceal hemorrhage and refractory ascites [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHepatic encephalopathy (HE) is a frequent and clinically significant complication following TIPS, often occurring within three months post-operation. It has been reported the incidence of HE after TIPS varies substantially 10\u0026ndash;50% among cirrhotic patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Overt-hepatic encephalopathy (OHE) correlates with poor clinical outcomes including impaired quality of life, recurrent hospitalizations, and higher mortality. Furthermore, the mortality risk dramatically pronounced in patients with grade II-IV HE, compared to grade 0 HE patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This adverse effect remains a key limiting factor in the broader clinical adoption of TIPS. Therefore, identification risk factors for OHE after TIPS is of significant clinical importance.\u003c/p\u003e\u003cp\u003ePrevious studies have identified several risk factors, including older age, higher Child-Pugh score, history of HE and lower serum sodium, as predictors of poor outcomes in patients with decompensated cirrhosis undergoing TIPS [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, the current landscape lacks both well-validated biomarkers and effective clinical tools specifically for post-TIPS HE. This underscores the critical need to develop more precise risk stratification methods and personalized treatment approaches for this patient population, which would empower clinicians to implement early therapeutic interventions for high-risk patient cohorts.\u003c/p\u003e\u003cp\u003eInsulin resistance (IR) is a hallmark of metabolic dysfunction and systemic inflammation. The triglyceride glucose (TyG) index was first introduced by professor Unger as a surrogate marker of IR [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Extensive research has demonstrated the TyG index's strong association with acute pancreatitis, carotid atherosclerosis, myocardial infarction and some tumors [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, an elevated TyG index was significantly linked with a poor prognosis of ischemic stroke [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Despite these established relationships, evidence regarding the TyG index's prognostic value in patients with decompensated liver cirrhosis undergoing TIPS remains limited. To address this knowledge gap, we performed a retrospective cohort study to evaluate the association between TyG index and the incidence of OHE after TIPS in decompensate cirrhosis patients.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population\u003c/h2\u003e\u003cp\u003eThis study conducted a retrospective analysis of cirrhotic patients who underwent TIPS in the Department of Gastroenterology of the General Hospital of Western Theater Command from January 2018 to January 2021. The indications for TIPS included uncontrollable or recurrent gastrointestinal variceal bleeding and refractory ascites, which were diagnosed by clinical manifestations, laboratory tests, endoscopy and imaging examinations.\u003c/p\u003e\u003cp\u003eExclusion criteria: (1) patients with previous HE before TIPS; (2) patients with history of splenectomy or splenic artery embolization; (3) patients who had undergone partial hepatectomy; (4) patients with other extrhepatic malignant tumors or acute severe conditions expected to shorten life expectancy to less than 6 months; (5) patients with incomplete clinical information; (4) Patients who died or were lost to follow-up within 12 months after TIPS.\u003c/p\u003e\u003cp\u003e All patients were informed of the benefits, risks and complications associated with the TIPS surgery, and received written informed consent. Finally, 58 patients were excluded, and a total of 146 patients were included in this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The study protocol was approved by the Ethical Committee of The General Hospital of Western Theater Command (Approval No. 2023EC5-ky058), and was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTIPS procedure\u003c/h3\u003e\n\u003cp\u003eThe TIPS procedure has been described in detail before and all procedures were performed by the same experienced gastroenterologist [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. All procedures were performed under local anesthesia. An 8-mm VIATORR self-expanding polytetrafluoroethylene-covered stent (Gore and Associates, United States) were implanted between the hepatic vein and portal vein. After TIPS creation, portal venography was performed to detect esophageal-gastric varices, and the varices were embolized once found.\u003c/p\u003e\n\u003ch3\u003eData collection and follow-up\u003c/h3\u003e\n\u003cp\u003ePatients were followed up at 1, 3, and 6 months postoperatively to monitor hepatic encephalopathy (HE) and survival rates. Demographic, clinical details and the parameters for TIPS procedure were gathered systematically during the patients\u0026rsquo; first admission. Patients were followed for the development of overt HE (OHE) and liver transplantation/death after TIPS insertion. According to the American Association for the Study of Liver Diseases (AASLD) guidelines [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], OHE was defined as West-Haven grade II-IV. Based on the occurrence of OHE during follow-up, patients were divided into an OHE group and a no-OHE group. The TyG index was calculated using the following formula: TyG\u0026thinsp;=\u0026thinsp;ln[fasting triglycerides (mg/dL) \u0026times; fasting glucose (mg/dL)/2] [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was conducted using SPSS 25.0. Quantitative data that followed a normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), and comparisons between the two were performed using the paired \u003cem\u003et\u003c/em\u003e-test; quantitative data that did not follow a normal distribution were expressed as M (P25 - P75), and comparisons between the two groups were conducted using the Mann-Whitney U test. Comparisons of qualitative data between the two groups were performed using the Chi-square or Fisher\u0026rsquo;s exact test. A \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistically significant differences. Binary Logistic regression analysis was used to determine the independent influencing factors for the occurrence of HE after TIPS surgery. The R 4.2.2 software was used to construct a risk prediction nomogram model for HE occurrence in patients after TIPS. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of the model for HE occurrence in patients after TIPS. Calibration curves and decision curves of the constructed model were drawn to assess the model's fit and predictive benefits.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eBaseline Characteristics of the Study Population\u003c/h2\u003e\u003cp\u003eA total of 146 patients who received TIPS treatment were hospitalized in the Department of Gastroenterology of the General Hospital of Western Theater Command and collected in this study. The patients were divided into the no-OHE group (79 cases) and OHE group (67 cases) based on the occurrence of OHE. Of the 146 patients, 56 (38.3%) were female and 90 (61.7%) were male, the mean age was 55 years, and the etiology was mostly hepatitis B cirrhosis (56.2%). The TyG index levels were 8.107 (7.724,8.395) in the no-OHE group and 8.748 (8.289,9.128) in OHE group, respectively (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The incidence of spontaneous peritonitis (SBP), diabetes, neutrophil count, monocyte count, blood glucose, triglycerides, and TyG index in the OHE group were significantly higher than those in the no-OHE group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics of the patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll patients(n\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo-OHE group(n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOHE group(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eStatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55 (47,63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (45,62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e60.5 (50.75,66.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (0.616)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (0.620)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e41 (0.612)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.918\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEtiology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHepatitis B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (0.562)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(0.570)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e37(0.552)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.930\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (0.103)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(0.101)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e7(0.104)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAutoimmunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (0.130)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(0.114)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e10(0.149)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (0.205)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(0.215)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e13(0.194)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (0.123)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (0.076)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e12 (0.179)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;3.850\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (0.123)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (0.063)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e13 (0.194)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;5.733\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAFP, ng/mL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.632\u0026thinsp;\u0026plusmn;\u0026thinsp;3.291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.234\u0026thinsp;\u0026plusmn;\u0026thinsp;1.936\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3.878\u0026thinsp;\u0026plusmn;\u0026thinsp;2.777\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-1.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbumin, g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.1 (31.5,38.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.9 (33.265,39.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e34.05 (30.075,38.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ=-1.591\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrealbumin, mg/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102.22 (80,127.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (84.7,137.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e94.24 (73.625,119.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ=-1.382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTBIL, \u0026micro;mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.427\u0026thinsp;\u0026plusmn;\u0026thinsp;21.264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.54\u0026thinsp;\u0026plusmn;\u0026thinsp;22.505\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e30.987\u0026thinsp;\u0026plusmn;\u0026thinsp;17.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.705\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.696\u0026thinsp;\u0026plusmn;\u0026thinsp;45.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.765\u0026thinsp;\u0026plusmn;\u0026thinsp;20.709\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e30.304\u0026thinsp;\u0026plusmn;\u0026thinsp;42.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-0.261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.935\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAST, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.817\u0026thinsp;\u0026plusmn;\u0026thinsp;33.951\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.037\u0026thinsp;\u0026plusmn;\u0026thinsp;25.951\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e40.602\u0026thinsp;\u0026plusmn;\u0026thinsp;44.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-1.666\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.211\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGGT, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64.955\u0026thinsp;\u0026plusmn;\u0026thinsp;108.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.082\u0026thinsp;\u0026plusmn;\u0026thinsp;97.486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e61.983\u0026thinsp;\u0026plusmn;\u0026thinsp;60.377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-1.474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALP, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107.324\u0026thinsp;\u0026plusmn;\u0026thinsp;76.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99.614\u0026thinsp;\u0026plusmn;\u0026thinsp;69.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e104.313\u0026thinsp;\u0026plusmn;\u0026thinsp;51.495\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-2.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTBA, umol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.918\u0026thinsp;\u0026plusmn;\u0026thinsp;28.624\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.703\u0026thinsp;\u0026plusmn;\u0026thinsp;22.116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e23.002\u0026thinsp;\u0026plusmn;\u0026thinsp;21.207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-1.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.195\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.200\u0026thinsp;\u0026plusmn;\u0026thinsp;0.152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.191\u0026thinsp;\u0026plusmn;\u0026thinsp;0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.207\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePT, seconds\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.678\u0026thinsp;\u0026plusmn;\u0026thinsp;1.701\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.526\u0026thinsp;\u0026plusmn;\u0026thinsp;1.622\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e13.737\u0026thinsp;\u0026plusmn;\u0026thinsp;1.937\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.648\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin, g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (71,97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (68.5,95.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e84 (70.5,103.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;0.581\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.561\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRBC, \u0026times;10\u003csup\u003e12\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.95 (2.58,3.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.980 (2.695,3.400)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2.915 (2.5,3.403)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ=-0.642\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.521\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBC, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.676\u0026thinsp;\u0026plusmn;\u0026thinsp;2.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.193\u0026thinsp;\u0026plusmn;\u0026thinsp;1.663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e4.587\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-2.468\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelet, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.24\u0026thinsp;\u0026plusmn;\u0026thinsp;56.932\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.880\u0026thinsp;\u0026plusmn;\u0026thinsp;69.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e70.170\u0026thinsp;\u0026plusmn;\u0026thinsp;51.180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.160\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutrophil, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.585\u0026thinsp;\u0026plusmn;\u0026thinsp;2.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.206\u0026thinsp;\u0026plusmn;\u0026thinsp;1.209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3.308\u0026thinsp;\u0026plusmn;\u0026thinsp;3.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-2.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocyte, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.705\u0026thinsp;\u0026plusmn;\u0026thinsp;0.497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.708\u0026thinsp;\u0026plusmn;\u0026thinsp;0.512\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.751\u0026thinsp;\u0026plusmn;\u0026thinsp;0.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-0.703\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.481\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonocyte, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.307\u0026thinsp;\u0026plusmn;\u0026thinsp;0.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.395\u0026thinsp;\u0026plusmn;\u0026thinsp;0.408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et=-2.716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTC, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.95 (2.4,3.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.95 (2.455,3.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2.895 (2.215,3.903)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.734\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.083\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTG, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.83 (0.63,1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.71 (0.545,0.905)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.97 (0.768,1.315)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;5.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.01 (0.76,1.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.02 (0.845,1.335)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.95 (0.668,1.245)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ=-0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.991\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.61 (1.24,2.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.55 (1.195,2.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.67 (1.248,2.128)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.962\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFBG mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.45 (5.17,8.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.8 (4.885,7.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e7.14 (5.83,10.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;4.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTyG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.336 (7.956,8.755)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.107 (7.724,8.395)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e8.748 (8.289,9.128)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;6.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrea, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e281 (220.8,348)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e274 (207.6,329.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e281.5 (225.45,357.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSCr, ummol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.931\u0026thinsp;\u0026plusmn;\u0026thinsp;23.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.789\u0026thinsp;\u0026plusmn;\u0026thinsp;20.712\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e76.102\u0026thinsp;\u0026plusmn;\u0026thinsp;31.743\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.267\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.131\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMELD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.476 (7.599,12.003)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.836 (7.004,11.929)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9.777 (7.903,12.316)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;0.907\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.364\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number of patients (%) where appropriate.\u003c/p\u003e\u003cp\u003eSBP, spontaneous peritonitis; AFP, alpha-fetoprotein; TBIL, Total bilirubin; ALT, alanine aminotransferase; AST aspartate aminotransferase; GGT, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; TBA, total bile acid; INR international normalized ratio; PT prothrombin time; RBC, red blood cell; WBC, white blood cell; TC, total cholesterol; TG, Triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; FBG, fasting blood glucose; TyG, triglyceride glucose index; SCr, serum creatinine; MELD, model for end-stage liver disease.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis of the predictive value of TyG index for the incidence of HE in patients after TIPS\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe inter-group analysis showed that the TyG index, TG, and FBG all had statistical significance between the two groups. To clarify the predictive value of these three indicators for the occurrence of HE after TIPS, a single-factor analysis of TyG index, TG, and FBG was conducted using the logistic regression model. The results indicated that all three indicators were risk factors for the occurrence of HE after TIPS in patients, and the TyG index had a more significant statistical significance (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\n\u003ch3\u003eAnalysis of risk factors for the incidence of hepatic encephalopathy after TIPS\u003c/h3\u003e\n\u003cp\u003eBased on the above research results, a single-factor analysis was conducted on the TyG index and baseline indicators. The indicators that were significant in the single-factor analysis (TyG index, white blood cell count, monocyte count, neutrophil count, diabetes incidence, SBP incidence) were then analyzed using the forward likelihood method of multivariate Logistic regression (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The results showed that the TyG index, neutrophil count, and SBP incidence were independent influencing factors for the occurrence of HE in patients after TIPS (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression analysis of HE occurrence in patients after TIPS surgery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultivariate analysis\u003c/p\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.026(0.997,1.055)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.965(0.494,1.885)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.918\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAFP, ng/mL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.060(0.951,1.181)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbumin, g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.956(0.890,1.026)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrealbumin, mg/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.996(0.988,1.004)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.338\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTBIL, \u0026micro;mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.998(0.983,1.014)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.001(0.994,1.008)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.794\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAST, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.010(0.997,1.023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGGT, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.003(0.999,1.006)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALP, U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.005(1.000,1.011)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTBA, umol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.006(0.994,1.019)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.353(0.040,3.137)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePT, seconds\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.929(0.764,1.129)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.459\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin, g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.003(0.987,1.019)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.701\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRBC, \u0026times;10\u003csup\u003e12\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.897(0.561,1.435)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBC, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.228(1.023,1.472)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelet, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.000(0.994,1.005)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutrophil, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.287(1.015,1.633)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.272(1.000,1.656)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocyte, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.268(0.654,2.457)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.482\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonocyte, \u0026times;10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.354(1.509,46.257)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTC, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.358(0.979,1.885)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.972(0.480,1.968)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.938\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.124(0.767,1.647)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.549\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTyG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.103(3.918,21.149)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.655(3.957,23.555)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrea, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.998(0.984,1.012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSCr, ummol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.002(0.999,1.005)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.363(0.128,0.999)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.212(0.061,0.736)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.281(0.094,0.834)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or number of patients (%) where appropriate.\u003c/p\u003e\u003cp\u003eSBP, spontaneous peritonitis; AFP, alpha-fetoprotein; TBIL, Total bilirubin; ALT, alanine aminotransferase; AST aspartate aminotransferase; GGT, γ-glutamyl transpeptidase; ALP, alkaline phosphatase; TBA, total bile acid; INR international normalized ratio; PT prothrombin time; RBC, red blood cell; WBC, white blood cell; TC, total cholesterol; TG, Triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; FBG, fasting blood glucose; TyG, triglyceride glucose index; SCr, serum creatinine.\u003c/p\u003e\n\u003ch3\u003eConstruction and efficacy verification of nomogram model for predicting the incidence of HE after TIPS\u003c/h3\u003e\n\u003cp\u003eBased on the above Logistic regression analysis results, a nomogram model for the incidence of HE in patients after TIPS was constructed and plotted using R language. The corresponding scores were calculated according to the levels of each factor in the nomogram model, and the total score was obtained by summing up the corresponding scores. A vertical line was drawn from the total score to the risk assessment axis below the prediction model, and the value at the intersection point was the risk of HE in patients after TIPS (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The ROC curve of the new model was plotted, and the AUC of the new model was 0.704, indicating that the new model had good predictive performance (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The calibration curve and decision curve (DCA) of the new model were plotted using R language, and the results indicated that the model had good fit (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), and the decisions made through this model could bring net benefits (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective study, we established for the first time that elevated TyG index significantly correlates with increased risks of OHE in decompensate cirrhosis patients after TIPS. Moreover, our findings introduce the TyG index as a practical, readily available tool for risk prediction for OHE occurrence in these patients.\u003c/p\u003e\u003cp\u003eGiven the substantial incidence of post-TIPS HE, early detection and preventive interventions are critical for optimizing both quality of life and long-term clinical outcomes in cirrhosis patients. Current prognostic scoring systems for post-TIPS HE are complicated, time-consuming and have limited efficacy. For example, although the Child-Pugh classification has been associated with HE risks prediction [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], its reliance on subjective elements (notably HE assessment) compromises scoring reproducibility and thus clinical reliability. These limitations underscore the urgent need to develop convenient, non-invasive biomarkers capable of reliably identifying post-TIPS HE high-risk groups at early stages.\u003c/p\u003e\u003cp\u003eIR is characterized by impaired cellular glucose uptake and utilization. Substantial evidence demonstrates that IR contributes to cardiovascular risk across diverse populations through multiple pathological mechanisms: (1) disruption of glucose and lipid homeostasis, (2) induction of oxidative stress and chronic inflammation, (3) endothelial dysfunction, and (4) ectopic lipid deposition [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The TyG index is a readily straightforward marker of IR, and numerous studies have shown a significant association between TyG and metabolic disorder-related diseases such as diabetes, obesity, and cardiovascular disease. For liver cirrhosis, there are also abnormal metabolic disorders. While, few studies focused on the TyG and HE occurrence after TIPS.\u003c/p\u003e\u003cp\u003eIn our study, logistic regression demonstrated that the TyG index, neutrophil count, and SBP incidence were independent influencing factors for the occurrence of OHE in patients after TIPS. Further, the nomogram model based on TyG also showed good predictive performance (AUC 0.704). In a retrospective study, the predictive efficacy of the Child-Pugh and MELD for post-TIPS HE was AUC\u0026thinsp;=\u0026thinsp;0.596 and AUC\u0026thinsp;=\u0026thinsp;0.641, respectively [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Compared with this research, our model exhibits superior predictive performance. These results indicate that TyG index could effectively identify patients at high risk of OHE after TIPS, offering a valuable tool for preoperative risk assessment. The index reflects disturbances in glucose and lipid metabolism, which are critical factors in post-TIPS HE. And previous studies have shown that diabetes was an independent risk factors for OHE in patients after TIPS and patients with diabetes have a high risk of developing OHE [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Additionally, hyperglycemia has been proven to induce oxidative stress through mitochondrial or endoplasmic reticulum dysfunction, systemic inflammation and microvascular endothelial impairment [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These metabolic disturbances collectively promote a pro-inflammatory and pro-coagulant state characterized by upregulated inflammatory mediators, enhanced apoptotic activity-all of which facilitates the systemic accumulation of neurotoxic substances, enabling their unrestricted passage across the blood-brain barrier and subsequent triggering of HE.\u003c/p\u003e\u003cp\u003ePrevious studies demonstrated a higher TyG index was correlated with increased visceral obesity in gastric cancer patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Notably, visceral fat area index has been found as a good indicator of HE in cirrhotic patients after TIPS [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. And patients with low visceral fat area had a higher risk of post-TIPS HE. Therefore, based on our results, we believe that the TyG index could potentially serve as a simple and cost-effective alternative to visceral fat area to predict the occurrence of HE. In addition, prophylactic treatment including use of small-diameter stents and oral administration lactulose or rifaximin in patients with high TyG index levels is an interesting and potentially valuable approach to reduce the risk of HE after TIPS.\u003c/p\u003e\u003cp\u003eThis study has several limitations that should be acknowledged. First, the retrospective design precluded assessment of TyG dynamic changes during follow-up. Second, while we adjusted for multiple confounders, potential residual confounding may be inevitable due to the single-center nature and modest sample size of our cohort. Finally, the cutoff value of TyG is derived from our own patient cohort and requires validation in multicenter populations to confirm its predictive utility. These limitations highlight the need for prospective, multicenter studies with comprehensive metabolic profiling to validate our findings and elucidate the TyG index's clinical utility in HE management.\u003c/p\u003e\u003cp\u003eIn conclusion, our findings establish the TyG index as a robust predictor of HE in patients after TIPS. These results position the TyG index as a clinically accessible tool for risk stratification in decompensate cirrhosis patients after TIPS, offering valuable prognostic information beyond conventional assessments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChengzhi Bai, Lanjing Wang,\u0026nbsp;Jianping Qin and Liang Zhang\u0026nbsp;designed the study and drafted the manuscript.\u0026nbsp;Yalun Chen, Dong Mu, Shumei Zheng and Shanhong Tang\u0026nbsp;collected the clinical data.\u0026nbsp;Liang Zhang and\u0026nbsp;Jianping Qin\u0026nbsp;reviewed the data and revised the manuscript. All authors approved the final version.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was performed according to the ethical guidelines of the Declaration of Helsinki and was approved and the need for consent to participate was waived by the Ethical Committee of The General Hospital of Western Theater Command, with the need for consent to participate waived (2023EC5-ky058).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eElliot B T, Neehar D P. 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FBXW7 alleviates hyperglycemia-induced endothelial oxidative stress injury via ROS and PARP inhibition. Redox Biol. 2022, 58:102530.\u003c/li\u003e\n\u003cli\u003eXiaogang S, Chongxi F, Chao W, Wuhan Y, Jichao T, Feng M, et al. Mitochondria fission accentuates oxidative stress in hyperglycemia-induced H9c2 cardiomyoblasts in vitro by regulating fatty acid oxidation. Cell Biol Int. 2024, 48(9):1378-1391.\u003c/li\u003e\n\u003cli\u003eJunbo Z, Zhenhua H, Yan G, Xin D, Xiuhua W, Yan H. Triglyceride-glucose index as a marker for visceral obesity in patients with gastric cancer. Front Nutr. 2025, 11:1515918.\u003c/li\u003e\n\u003cli\u003eChuhan W, Yue T, Jin G, Zichen Z, Yonggang L. Low adipose tissue index as an indicator of hepatic encephalopathy in cirrhotic patients following transjugular intrahepatic portosystemic shunt. Abdom Radiol (NY). 2023, 48(4):1454-1467.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Transjugular intrahepatic portosystemic shunt, Hepatic encephalopathy, Triglyceride glucose index, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-7008044/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7008044/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHepatic encephalopathy (HE) represents a frequent and clinically significant complication following transjugular intrahepatic portosystemic shunt (TIPS) placement, profoundly affecting both patient quality of life and long-term prognosis. Early assessment and timely identification of potential post-TIPS HE are critically important for improving clinical outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eCirrhotic patients undergone TIPS were retrospectively enrolled from January 2018 to November 2021 in this study. Demographic information and clinical materials were retrospectively collected. Based on the occurrence of overt hepatic encephalopathy (OHE) postoperatively, patients were stratified into no-OHE and OHE groups. Univariate and multivariate logistic regression were performed to identify predictors of post-TIPS OHEs. And a nomogram was developed using independent risk factors. ROC curve analysis was plotted to assess the predictive ability of the triglyceride glucose (TyG) index. Calibration plots and Decision curve analysis (DCA) was used to evaluate the model's fit and predictive benefits.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 146 patients were retrospectively enrolled in this study, of which 67 suffered from OHE. Compared with the no-OHE group, TyG index was significantly higher in the OHE group (8.748 (8.289,9.128) vs 8.107 (7.724,8.395), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Multivariate logistic regression analysis showed that TyG index, neutrophil count, and SBP incidence were independent risk factors for post-TIPS OHE (OR 9.655, 95% CI 3.957\u0026ndash;23.555 \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001; OR 1.272, 95% CI 1.000\u0026ndash;1.656 \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05; OR 0.212, 95% CI 0.061\u0026ndash;0.736 \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015, respectively). Then a nomogram model for the incidence of OHE was constructed and the ROC curve of the new model was plotted with the AUC of the new model 0.704, indicating a good predictive performance. Calibration plots and Decision curve analysis (DCA) also showed the model had good fit.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eTyG index serves as an independent predictor and may represent a novel prognostic biomarker for predicting post-TIPS HE.\u003c/p\u003e","manuscriptTitle":"Triglyceride Glucose Index predicts the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-01 10:48:57","doi":"10.21203/rs.3.rs-7008044/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-07-28T16:41:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-01T11:40:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-01T04:01:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-01T04:00:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-06-30T08:16:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1c104e0-9ae9-452e-8346-bf72486fac9c","owner":[],"postedDate":"August 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-01T10:48:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-01 10:48:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7008044","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7008044","identity":"rs-7008044","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}