The qEEG-TIPS score: Development of a predictive model for recurrent overt hepatic encephalopathy after elective TIPS

BACKGROUND & AIMS: Overt hepatic encephalopathy (OHE) continues to be the primary complication following transjugular intrahepatic portosystemic shunt (TIPS) placement. It significantly impairs patients' health-related quality of life, particularly in its recurrent and persistent forms, and may outweigh the benefits of the procedure. This study aimed to develop and internally validate a prognostic score incorporating quantified electroencephalography (qEEG) to predict the risk of post-TIPS recurrent OHE at 3 and 6 months. METHODS: We prospectively enrolled 161 consecutive patients with cirrhosis undergoing elective TIPS for refractory or recurrent ascites or secondary prophylaxis of variceal bleeding. All patients underwent qEEG assessment using validated spectral analysis criteria prior to TIPS placement. A multivariable Cox regression model was constructed to estimate the risk of recurrent OHE. Model performance was evaluated using time-dependent ROC curves, calibration plots, decision curve analysis, and internal validation via bootstrap resampling (B = 1,500). RESULTS: Independent predictors of recurrent OHE included age, serum albumin, prior OHE history, and qEEG alterations, which were incorporated into the novel qEEG-TIPS score. The time-dependent AUCs were 0.76 (95% CI 0.70-0.82) and 0.80 (95% CI 0.76-0.85) at 3 and 6 months, respectively. The score identified high-risk patients with a significantly greater incidence of recurrent OHE at 6 months (48% vs. 8% in low-risk patients, p