# Animal naming test at discharge is associated with hepatic encephalopathy after elective TIPS

## TL;DR

The animal naming test at discharge helps predict the risk of brain-related complications after a liver procedure called TIPS.

## Contribution

The study shows that the animal naming test at discharge, not before TIPS, is a novel predictor of overt hepatic encephalopathy.

## Key findings

- ANT at discharge was an independent predictor of OHE with an 8% increased risk per 1-point decrease.
- Pre-TIPS ANT was not predictive of OHE, but post-TIPS ammonia levels and ANT were.
- The cumulative incidence of OHE was 30% after elective TIPS placement.

## Abstract

Overt hepatic encephalopathy (OHE) is the most feared complication after transjugular intrahepatic portosystemic shunt (TIPS) placement. We aimed to evaluate the usefulness of the animal naming test (ANT) in predicting the occurrence of OHE after elective TIPS placement.

The ANT (1 min) was evaluated before TIPS, at discharge, and at 1, 3, and 6 months in all patients treated with elective TIPS between September 2019 and November 2024.

We included 100 consecutive patients (80% men; median age 59 years; median MELD score 11). Indications for TIPS were ascites, secondary prophylaxis, hydrothorax, and pre-surgery in 63%, 19%, 5%, 13%, respectively; 24% had a history of OHE. The median ANT before TIPS was 21 (IQR 17–27). The cumulative incidence of OHE was 30%, considering death and liver transplantation as competing events. In multivariate analysis, independent predictors of OHE development were age (hazard ratio [HR] 1.04; 95% CI 1.00-1.09; p = 0.02), pre-TIPS ammonia level (HR 1.01; 95% CI 1.00-1.03; p = 0.02), ammonia level at discharge (HR 1.01; 95% CI 1.01-1.03; p = 0.04), and ANT at discharge (HR 0.89; 95% CI 0.81-0.97; p = 0.005), but not ANT before TIPS. After discharge, the predictive value of ANT was stable for the diagnosis of subsequent OHE.

ANT at discharge may be useful in identifying patients at higher risk of OHE after TIPS.

Overt hepatic encephalopathy (OHE) remains a major limitation of transjugular intrahepatic portosystemic shunt (TIPS) placement. While the animal naming test (ANT) before TIPS could not accurately predict the development of OHE, both ANT and ammonia after TIPS were predictive of OHE. Each decrease of ANT of 1 point was associated with an increased risk of OHE of 8%. Incorporating this test into routine post-procedural assessment could improve early identification of high-risk patients, guide preventive strategies, and optimize follow-up.

Image 1

•ANT before TIPS is not predictive of the subsequent development of OHE.•In this study, both ANT and ammonia after TIPS were predictive of subsequent development of OHE.•Each 1-point decrease in ANT was associated with an increased risk of OHE of 8%.

ANT before TIPS is not predictive of the subsequent development of OHE.

In this study, both ANT and ammonia after TIPS were predictive of subsequent development of OHE.

Each 1-point decrease in ANT was associated with an increased risk of OHE of 8%.