Abstract
AIMS: This research aims to explore the predictive value of the visceral-to-subcutaneous fat area ratio (V/S ratio) for post-TIPS overt hepatic encephalopathy (OHE) and transplant-free survival (TFS). METHODS: A total of 239 cirrhosis patients were included. Receiver operating characteristic (ROC) curves were generated to identify cutoff points for both visceral fat area (VFA) and VFA to subcutaneous fat area (SFA) ratio (V/S ratio) as predictors of 1-year OHE and 2-year TFS. Kaplan-Meier and Cox proportional hazards modeling to determine associations between body composition characteristics and 1-year OHE and 2-year TFS. RESULTS: ROC analysis and AUROC demonstrated that V/S ratio and VFA had significant and satisfactory prediction ability for 1-year OHE at a level of 1.041 (AUROC 0.817, p < 0.001) and 87.12cm(2) (AUROC 0.705, p < 0.001), respectively. In the Cox multivariate regression model, age, V/S ratio, creatinine, and combined sarcopenia and myosteatosis were risk factors for 1-year OHE. High V/S ratio was associated with a 1.75-fold overall risk of 1-year OHE (HR 1.748, 95% CI 1.438-2.124, p < 0.001) and a 1.55-fold overall risk of death/liver transplantation (HR 1.547, 95% CI 1.199-1.997, p = 0.001) compared to patients with a low V/S ratio. CONCLUSION: Preoperative assessment of the V/S ratio is beneficial for predicting OHE and TFS after TIPS.