# Neurofilament Light Chains in Serum Predict Post—Transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy

## TL;DR

This study finds that neurofilament light chains in blood can predict severe brain-related complications after a liver procedure called TIPS.

## Contribution

The study identifies serum neurofilament light chains (NfL) as a novel predictive biomarker for post-TIPS hepatic encephalopathy.

## Key findings

- Higher serum NfL levels independently predict post-TIPS overt hepatic encephalopathy.
- NfL levels remain stable until 30 days post-TIPS and then decrease by 180 days.
- GFAP levels showed no predictive value for post-TIPS complications.

## Abstract

Hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) insertion constitutes a frequent and severe complication. However, there is a lack of robust predictive biomarkers for post‐TIPS HE, so far. This study evaluated the usefulness of neurofilament light chains (NfL) and glial fibrillary acidic protein (GFAP) in serum for predicting post‐TIPS HE. Around 144 patients with cirrhosis from three centers were prospectively included and monitored for the occurrence of post‐TIPS overt HE, liver transplantation, and death. Serum NfL and GFAP were evaluated before TIPS insertion using the single molecule array technology. In a subgroup of patients sequential NfL and GFAP levels were assessed at 30‐ and 180‐days post‐TIPS. While higher NfL levels (sHR 1.01, p = 0.036) were independently associated with post‐TIPS OHE after adjusting for other risk factors, GFAP levels had no predictive ability. Consistently, only elevated NfL levels were associated with a higher risk of death/liver transplantation in multivariable analyses. Sequential measurements of NfL at 30 and 180 days after TIPS revealed that NfL levels remain constant until Day 30 followed by a decrease at day 180. Notably, GFAP levels did not change over time. Thus, NfL could be a valuable biomarker for identifying high‐risk patients for post‐TIPS HE.

Hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) insertion constitutes a frequent and severe complication, however, biomarkers are currently scarce. The results of this study indicate that neurofilament light chains (NfL) in serum, but not glial fibrillary acidic protein (GFAP), is a useful biomarker identifying patients at a higher risk for post‐TIPS HE. In the future, NfL might serve as a promising biomarker to improve personalized management of patients receiving a TIPS.