Intermediate and long-term survival prediction using prognostic scores in patients undergoing salvage TIPS for uncontrolled variceal bleeding.

Autor:	Krige JEJ; Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa., Jonas EG; Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa., Setshedi M; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa., Beningfield SJ; Department of Radiology, Faculty of Health Sciences, University of Cape Town, South Africa., Kotze UK; Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa., Bernon MM; Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa., Burmeister S; Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa., Kloppers JC; Surgical Gastroenterology Unit, Groote Schuur Hospital, and Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
Jazyk:	angličtina
Zdroj:	South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie [S Afr J Surg] 2024 May; Vol. 62 (2), pp. 54-57.
Abstrakt:	Background: This study investigated the value of prognostic scores to predict 90-day, 1-, 3- and 5-year survival after salvage TIPS (sTIPS) in patients with exsanguinating variceal bleeding who failed endoscopic intervention. Methods: The Model for End-Stage Liver Disease (MELD), Model for End-Stage Liver Disease Sodium (MELDNa), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Child-Pugh (C-P) grades and scores were calculated using Kaplan-Meier curves and Cox proportional hazards models in sTIPS patients treated between August 1991 and November 2020. Results: Thirty-four patients (29 men, 5 women), mean age 52 years, SD ± 11.6 underwent sTIPS which controlled bleeding in 32 (94%) patients. Ten (29.4%) patients died in hospital at a median of 4.8 (range 1-10) days. On bivariate analysis, C-P score ≥ 10 ( p = 0.017), high C-P grade ( p = 0.048), MELD ≥ 15 ( p = 0.010), MELD-Na score ≥ 22 ( p < 0.001) and APACHE II score ≥ 15 ( p < 0.001) predicted 90-day mortality. Individual clinical characteristics associated with 90-day mortality were grade 3 ascites ( p = 0.029), > 10 units of blood transfused ( p = 0.004), balloon tube placement ( p < 0.001), endotracheal intubation (< 0.001) and inotrope support ( p < 0.001). The overall 90-day, 1-, 3- and 5-year survival rates were 67.6%, 55.9%, 26.5% and 20.6% respectively. Nine patients (26.5%) were alive at a median of two years (range 1-18 years) post-TIPS. Patients with C-P grade A, C-P score < 10, MELD score < 15, MELD-Na score < 22 and APACHE II score < 15 had significantly better 90-day, 1-, 3- and 5-year survival rates. Conclusion: Although sTIPS controlled variceal bleeding in 94% of patients after failed endoscopic therapy, in-hospital mortality was 29% and less than one quarter were alive after five years. The selected cut-off values for the nominated scoring systems accurately predicted 90-day mortality and long-term survival. (Copyright© Authors.)
Databáze:	MEDLINE
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