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

Autor: Lena Pfaff, Marlene E Reincke, Karl Heinz Weiss, Christoph Neumann-Haefelin, Martin Rössle, Roman Kloeckner, Lukas Sturm, Hauke Heinzow, Lara Volkwein, Carsten Meyer, Felix Hahn, Michael Praktiknjo, Karel Caca, Alexander Zipprich, Maximilian J. Brol, Guohong Han, Leon Louis Seifert, Jonel Trebicka, Johannes Kluwe, Dominik Bettinger, Frank Erhard Uschner, Christian Jansen, Tobias Boettler, Felix Piecha, Jan Patrick Huber, Arthur Schmidt, Yong Lv, Hendrik Luxenburger, Christoph Klinger, Christian Rupp, Robert Thimme, Michael Schultheiss
Rok vydání: 2020
Předmět:
0301 basic medicine
Liver Cirrhosis
Male
medicine.medical_specialty
Cirrhosis
medicine.medical_treatment
Population
Clinical Decision-Making
Serum Albumin
Human
Esophageal and Gastric Varices
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Ascites
medicine
Secondary Prevention
Humans
education
Aged
Retrospective Studies
education.field_of_study
Framingham Risk Score
Hepatology
Proportional hazards model
business.industry
Age Factors
Bilirubin
Middle Aged
medicine.disease
Prognosis
Survival Rate
030104 developmental biology
Treatment Outcome
Research Design
Creatinine
Cohort
Portal hypertension
030211 gastroenterology & hepatology
Female
medicine.symptom
Portasystemic Shunt
Transjugular Intrahepatic
business
Gastrointestinal Hemorrhage
Transjugular intrahepatic portosystemic shunt
Zdroj: Journal of hepatology. 74(6)
ISSN: 1600-0641
Popis: 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.
Databáze: OpenAIRE
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