Rifaximin for Primary prophylaxis of overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt: A cohort analysis - 07/01/26
, Yuzheng Zhuge c, ⁎ , Feng Zhang c, ⁎ 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. |
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-17,012,479). 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).
Conclusions |
Six-month rifaximin prophylaxis following TIPS significantly reduced the incidence of early OHE in patients with cirrhosis.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Keywords : Rifaximin, Transjugular intrahepatic portosystemic shunt(TIPS), Overt hepatic encephalopathy(OHE), Primary prophylaxis, Cirrhosis
Plan
Vol 50 - N° 2
Article 102751- février 2026 Retour au numéro
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