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

Autor: Bettinger D; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Germany. Electronic address: dominik.bettinger@uniklinik-freiburg.de., Sturm L; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Germany., Pfaff L; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany., Hahn F; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany., Kloeckner R; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany., Volkwein L; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany., Praktiknjo M; Department of Internal Medicine I, University of Bonn, Bonn, Germany., Lv Y; Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China., Han G; Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Centre for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China; Department of Liver Diseases and Digestive Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital of Northwestern University, Xi'an, China., Huber JP; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany., Boettler T; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; Berta-Ottenstein Programme, Faculty of Medicine, University of Freiburg, Germany., Reincke M; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany., Klinger C; Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany., Caca K; Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany., Heinzow H; Department of Gastroenterology and Hepatology, University Hospital Münster, Germany., Seifert LL; Department of Gastroenterology and Hepatology, University Hospital Münster, Germany., Weiss KH; Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany; Krankenhaus Salem der evang, Stadtmission Heidelberg, Heidelberg, Germany., Rupp C; Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany., Piecha F; I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg, Germany., Kluwe J; I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg, Germany., Zipprich A; Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Halle, Germany., Luxenburger H; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; IMM-PACT, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Germany., Neumann-Haefelin C; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany., Schmidt A; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany., Jansen C; Department of Internal Medicine I, University of Bonn, Bonn, Germany., Meyer C; Department of Radiology, University Hospital Bonn, Bonn, Germany., Uschner FE; Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany., Brol MJ; Department of Internal Medicine I, University of Bonn, Bonn, Germany., Trebicka J; Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain., Rössle M; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; PraxisZentrum für Gastroenterologie und Endokrinologie, Freiburg, Germany., Thimme R; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany., Schultheiss M; Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
Jazyk: angličtina
Zdroj: Journal of hepatology [J Hepatol] 2021 Jun; Vol. 74 (6), pp. 1362-1372. Date of Electronic Publication: 2021 Jan 26.
DOI: 10.1016/j.jhep.2021.01.023
Abstrakt: Background & Aims: 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.
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.
Competing Interests: 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.
(Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: