{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:12:15Z","timestamp":1788520335474,"version":"build-2803163510"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Numerous risk-prediction models for hepatic encephalopathy (HE) after TIPS have been proposed, but their quality, discrimination, and clinical utility remain uncertain. We aimed to identify key predictors of post-TIPS HE and to critically appraise existing models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta-analysis of observational studies (inception 15 July 2025) from Chinese (VIP, Wanfang, CNKI, and CBM) and international (Embase, PubMed, Web of Science, and Cochrane Library) databases. Model quality and bias were assessed via PROBAST. Pooled AUCs and predictor effect sizes were calculated using STATA 15.0 and MedCalc.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 24 studies (5,197 patients) yielded 32 unique models; the incidence of HE ranged from 19.9 to 46.6%. Discrimination was generally good (AUC range, 0.64\u20131.00; 30 models &amp;gt;0.70; 22\u202f&amp;gt;\u202f0.80). PROBAST flagged high bias\u2014especially in model analysis. A meta-analysis produced a summary AUC of 0.815 (95%CI, 0.780\u20130.849). Consistent predictors (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01) included older age, diabetes, higher Child-Pugh score\/class, elevated ammonia, and increased portal-to-splenic vein diameter ratio.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Existing post-TIPS HE models demonstrate strong discrimination but suffer methodological limitations and bias. Future studies should employ multicenter cohorts, harmonized definitions, rigorous analytics, and external validation to yield robust, clinically actionable tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42024597699<\/jats:ext-link>\n                      , CRD42024597699.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1707035","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:32:26Z","timestamp":1770013946000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk prediction models for hepatic encephalopathy following TIPS: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ziji","family":"Fang","sequence":"first","affiliation":[{"name":"School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenwei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZaiChun","family":"Pu","sequence":"additional","affiliation":[{"name":"Xindu District People's Hospital of Chengdu","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of PICC Nursing Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Day Surgery Ward, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobin","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Retired Personnel, Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S68","DOI":"10.1016\/j.jhep.2008.01.021","article-title":"The management of portal hypertension: rational basis, available treatments and future options","volume":"48","author":"Bosch","year":"2008","journal-title":"J Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1097\/HEP.0000000000000530","article-title":"AASLD practice guidance on the use of TIPS, variceal embolization, and retrograde transvenous obliteration in the management of variceal hemorrhage","volume":"79","author":"Lee","year":"2024","journal-title":"Hepatology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S135","DOI":"10.1016\/j.jhep.2021.01.027","article-title":"Management of the major complications of cirrhosis: beyond guidelines","volume":"75","author":"Garcia-Pagan","year":"2021","journal-title":"J Hepatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.jhep.2023.04.028","article-title":"TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis","volume":"79","author":"Larrue","year":"2023","journal-title":"J Hepatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1016\/j.jhep.2013.06.014","article-title":"TIPS: 25 years later","volume":"59","author":"R\u00f6ssle","year":"2013","journal-title":"J Hepatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1148\/radiol.2015150369","article-title":"Is post-TIPS anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? 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