OBJECTIVES: To evaluate hepatic encephalopathy (HE) incidence after transjugular 
intrahepatic portosystemic shunt (TIPS) and classify by gravity and frequency.
METHODS: This is a retrospective study of 75 patients with no previous episodes 
of HE who underwent TIPS between 2008 and 2014 with clinical follow-up after 6 
and 12 months. Patient risk factors evaluated include age, INR (international 
normalized ratio), creatinine, bilirubin, and MELD score (Model for End-of-stage 
Liver Disease). HE was reported using two classifications: (1) gravity divided 
in moderate (West-Haven grades I-II) and severe (III-IV); (2) frequency divided 
in episodic and recurrent/persistent.
RESULTS: Overall HE incidence was 36% at 6 months, with 12 month incidence 
significantly decreased to 27% (p = 0.02). 13/75 (17%) patients had one episode 
of moderate HE, while 3/75 (4%) patients had severe recurrent/persistent HE. Age 
was the only pre-TIPS risk predictor. Post-TIPS bilirubin and INR showed 
variations from basal values only in the presence of diagnosed HE. Bilirubin 
significantly increased (p = 0.03) in correlation to HE severity, whereas INR 
changes correlated with temporal frequency (p = 0.04). HE distribution 
classified for severity is similar at 6 and 12 months, whereas when classified 
for frequency shows significant differences (p = 0.04).
CONCLUSIONS: A classification by gravity and frequency attests post-TIPS HE as a 
manageable risk. Monitoring of bilirubin and INR may help on clinical management 
risk stratification.