Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival.

Age Factors Aged Ascites / surgery Bilirubin / blood Clinical Decision-Making / methods Creatinine / blood Esophageal and Gastric Varices / surgery Female Gastrointestinal Hemorrhage / surgery Humans Liver Cirrhosis / surgery Male Middle Aged Portasystemic Shunt, Transjugular Intrahepatic / adverse effects Prognosis Research Design Retrospective Studies Risk Factors Secondary Prevention / methods Serum Albumin, Human / analysis Survival Rate Treatment Outcome

Child-Pugh score MELD score Prognosis liver cirrhosis risk stratification transjugular intrahepatic portosystemic shunt

Journal

Journal of hepatology

ISSN: 1600-0641

Titre abrégé: J Hepatol

Pays: Netherlands

ID NLM: 8503886

Informations de publication

Date de publication:
06 2021

Historique:

received: 30 09 2020

revised: 12 01 2021

accepted: 12 01 2021

pubmed: 29 1 2021

medline: 29 1 2022

entrez: 28 1 2021

Statut: ppublish

Résumé

Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an effective and safe treatment for complications of portal hypertension. Survival prediction is important in these patients as they constitute a high-risk population. Therefore, the aim of our study was to develop an alternative prognostic model for accurate survival prediction after planned TIPS implantation. A total of 1,871 patients with de novo TIPS implantation for ascites or secondary prophylaxis of variceal bleeding were recruited retrospectively. The study cohort was divided into a training set (80% of study patients; n = 1,496) and a validation set (20% of study patients; n = 375). Further, patients with early (preemptive) TIPS implantation due to variceal bleeding were included as another validation cohort (n = 290). Medical data and overall survival (OS) were assessed. A Cox regression model was used to create an alternative prediction model, which includes significant prognostic factors. Age, bilirubin, albumin and creatinine were the most important prognostic factors. These parameters were included in a new score named the Freiburg index of post-TIPS survival (FIPS). The FIPS score was able to identify high-risk patients with a significantly reduced median survival of 5.0 (3.1-6.9) months after TIPS implantation in the training set. These results were confirmed in the validation set (median survival of 3.1 [0.9-5.3] months). The FIPS score showed better prognostic discrimination compared to the Child-Pugh, MELD, MELD-Na score and the bilirubin-platelet model. However, the FIPS score showed insufficient prognostic discrimination in patients with early TIPS implantation. The FIPS score is superior to established scoring systems for the identification of high-risk patients with a worse prognosis following elective TIPS implantation. Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective treatment for patients with cirrhosis and clinically significant portal hypertension. However, risk stratification is a major challenge in these patients as currently available scoring systems have major drawbacks. Age, bilirubin, albumin and creatinine were included in a new risk score which was named the Freiburg index of post-TIPS survival (FIPS). The FIPS score can identify patients at high risk and may guide clinical decision making.

Sections du résumé

BACKGROUND & AIMS

METHODS

A total of 1,871 patients with de novo TIPS implantation for ascites or secondary prophylaxis of variceal bleeding were recruited retrospectively. The study cohort was divided into a training set (80% of study patients; n = 1,496) and a validation set (20% of study patients; n = 375). Further, patients with early (preemptive) TIPS implantation due to variceal bleeding were included as another validation cohort (n = 290). Medical data and overall survival (OS) were assessed. A Cox regression model was used to create an alternative prediction model, which includes significant prognostic factors.

RESULTS

Age, bilirubin, albumin and creatinine were the most important prognostic factors. These parameters were included in a new score named the Freiburg index of post-TIPS survival (FIPS). The FIPS score was able to identify high-risk patients with a significantly reduced median survival of 5.0 (3.1-6.9) months after TIPS implantation in the training set. These results were confirmed in the validation set (median survival of 3.1 [0.9-5.3] months). The FIPS score showed better prognostic discrimination compared to the Child-Pugh, MELD, MELD-Na score and the bilirubin-platelet model. However, the FIPS score showed insufficient prognostic discrimination in patients with early TIPS implantation.

CONCLUSIONS

The FIPS score is superior to established scoring systems for the identification of high-risk patients with a worse prognosis following elective TIPS implantation.

LAY SUMMARY

Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a safe and effective treatment for patients with cirrhosis and clinically significant portal hypertension. However, risk stratification is a major challenge in these patients as currently available scoring systems have major drawbacks. Age, bilirubin, albumin and creatinine were included in a new risk score which was named the Freiburg index of post-TIPS survival (FIPS). The FIPS score can identify patients at high risk and may guide clinical decision making.

Identifiants

DOI: 10.1016/j.jhep.2021.01.023 PMID: 33508376

pubmed: 33508376

pii: S0168-8278(21)00035-0

doi: 10.1016/j.jhep.2021.01.023

pii:

doi:

Substances chimiques

Creatinine AYI8EX34EU

Bilirubin RFM9X3LJ49

Serum Albumin, Human ZIF514RVZR

Types de publication

Journal Article Observational Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

1362-1372

Commentaires et corrections

Type : CommentIn

Informations de copyright

Déclaration de conflit d'intérêts

Conflict of interest JT: Grants: Gore, Consultant: Martins Pharma, Ironwood, Gore, Alexion, BMS, Grifols, Sequana Medicals, Versantis, Sponsored lectures (National or International): Gilead, Gore, Alexion, BMS, Grifols, Sequana Medicals, Norgine, Intercept. DB: Consultant: Bayer Healthcare, Boston Scientific, Shionogi. Lectures: Falk Foundation. LS: Lectures: Falk Foundation. RK: Consultant: Boston Scientific, Bristol-Myers Squibb, Guerbet, Roche, and SIRTEX. Lectures: BTG, Guerbet, Ipsen, SIRTEX, MSD Sharp & Dohme. MS: Consultant: Bayer Healthcare, L.W.Gore Lectures: Falk Foundation. Please refer to the accompanying ICMJE disclosure forms for further details.