Rifaximin for Primary prophylaxis of Overt Hepatic Encephalopathy After Transjugular intrahepatic portosystemic shunt: A Cohort Analysis - 24/12/25

Doi : 10.1016/j.clinre.2025.102751

Chuanfu Ding ^1,^{^{#
contributed equally.}}, Youwei Xing ^1,^{^{#
contributed equally.}}, Siwei Liang ^1,^{^{#
contributed equally.}}, Chunxiang Wang ^2,^{^{#
contributed equally.}}, Wei Zhang ³, Huan Chen ¹, Xueqian Li ³, Yuyun Jia ³, Zihao Cai ¹, Wei Li ³, Yang Cheng ³, Song Zhang ³, Jiangqiang Xiao ³, Lei Wang ³, Qin Yin ^3,^⁎ , Yuzheng Zhuge ^3,^⁎ , Feng Zhang ^3,^⁎
¹ Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
² Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
³ Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China

^⁎Corresponding author. Qin Yin, 321#, Zhongshan Road, Nanjing 210008, Jiangsu, China. Tel: +86-025-83106666, +86-13951872835; Fax: +86-025-83304616.321#, Zhongshan RoadNanjingJiangsu210008China^⁎⁎Corresponding author. Yuzheng Zhuge, 321#, Zhongshan Road, Nanjing 210008, Jiangsu, China. Tel: +86-025-83106666, +86-13951872835; Fax: +86-025-83304616.321#, Zhongshan RoadNanjingJiangsu210008China^⁎⁎⁎Corresponding author. Feng Zhang, 321#, Zhongshan Road, Nanjing 210008, Jiangsu, China. Tel: +86-025-83106666, +86-13951872835; Fax: +86-025-83304616.321#, Zhongshan RoadNanjingJiangsu210008China

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Wednesday 24 December 2025

Highlights

•	First study evaluating rifaximin for primary prophylaxis of post-TIPS OHE in patients with viral cirrhosis, addressing a gap in existing research.
•	Retrospective cohort design based on prospectively registered data, combined with 1:1 propensity score matching (PSM) to reduce confounding bias.
•	Dynamic monitoring of blood ammonia and liver function markers, demonstrating rifaximin’s potential short- and long-term protective effects on the gut-liver-brain axis.

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Abstract

Background & Aims

Transjugular intrahepatic portosystemic shunt (TIPS) is linked to an elevated risk of overt hepatic encephalopathy (OHE), yet evidence supporting primary prophylaxis for post-TIPS OHE remains limited. This study aimed to evaluate whether rifaximin reduces the incidence of post-TIPS OHE in cirrhotic patients.

Methods

A retrospective analysis was conducted on 72 patients who received rifaximin (400 mg twice daily) for 6 months after TIPS (rifaximin group). A matched control group (n=72) was recruited from a randomized clinical trial (ChiCTR-INR-17012479). The primary endpoint was the occurrence of OHE within 6 months. Secondary endpoints included 1-year mortality, rebleeding episodes, stent dysfunction, and improvements in liver function.

Results

The 6-month incidence of OHE was significantly lower in the rifaximin group (21%, 15/72) than in the control group (40%, 29/72; P=0.011). The risk difference was -19.5% (95% confidence interval [CI]: -34.2% to -4.7%), with an odds ratio (OR) of 0.39 (95% CI: 0.19–0.82). Kaplan-Meier analysis demonstrated a significantly reduced cumulative risk of OHE in the rifaximin group (log-rank P=0.009). No significant differences were observed between groups in terms of mortality, rebleeding, or stent dysfunction (all P>0.05).