Objective To investigate the predictive value of age combined with albumin-bilirubin (ALBI) score for the occurrence of overt hepatic encephalopathy (OHE) in patients with cirrhosis complicated by esophageal and gastric variceal bleeding (EGVB) after transjugular intrahepatic portosystemic shunt (TIPS).

Methods A retrospective analysis was performed on the clinical data of 87 patients with cirrhosis complicated by EGVB who underwent TIPS. The patients were followed up for 6 months, and were divided into OHE group (27 cases) and non-OHE group (60 cases) based on whether OHE occurred. The indicators with significant differences between the two groups were screened out through univariate analysis, and binary Logistic regression analysis was performed to identify the independent risk factors for OHE occurrence. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the individual and combined independent risk factors for OHE. The differences in area under the curve (AUC) were compared using MedCalc software.

Results Among 87 patients, 27 developed OHE within 6 months after surgery, with a prevalence rate of 31.03%. Univariate analysis showed that there were significant differences in age, albumin, serum sodium, and ALBI score between the OHE group and the non-OHE group (P < 0.05). Binary Logistic regression analysis showed that age (OR=1.08; 95%CI, 1.02 to 1.14; P=0.01) and ALBI score (OR=13.68; 95%CI, 3.00 to 62.44; P < 0.01) were independent risk factors for OHE in patients with cirrhosis complicated by EGVB after TIPS. ROC curve analysis showed that the AUC for age and ALBI score in predicting OHE were 0.67 (95%CI, 0.55 to 0.79; P=0.01)and 0.72 (95%CI, 0.60 to 0.85; P < 0.01), respectively; the AUC for age combined with ALBI score in predicting OHE was 0.80 (95%CI, 0.70 to 0.91; P < 0.01), with a sensitivity of 77.8% and a specificity of 75.0%. There was no significant difference in the AUC by age and ALBI score alone in predicting OHE (P>0.05); however, the AUC for age combined with ALBI score in predicting OHE was greater than that of age or ALBI score alone in predicting OHE, and the difference was statistically significant (P < 0.05).

Conclusion Age and ALBI score are independent risk factors for the occurrence of OHE in patients with cirrhosis complicated by EGVB after TIPS. The combination of age and ALBI score has a higher predictive efficacy in predicting OHE than age or ALBI score alone.