Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival
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...
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
26 January 2021
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| In: |
Journal of hepatology
Year: 2021, Jahrgang: 74, Heft: 6, Pages: 1362-1372 |
| ISSN: | 1600-0641 |
| DOI: | 10.1016/j.jhep.2021.01.023 |
| Online-Zugang: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jhep.2021.01.023 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0168827821000350 
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| Verfasserangaben: | Dominik Bettinger, Lukas Sturm, Lena Pfaff, Felix Hahn, Roman Kloeckner, Lara Volkwein, Michael Praktiknjo, Yong Lv, Guohong Han, Jan Patrick Huber, Tobias Boettler, Marlene Reincke, Christoph Klinger, Karel Caca, Hauke Heinzow, Leon Louis Seifert, Karl Heinz Weiss, Christian Rupp, Felix Piecha, Johannes Kluwe, Alexander Zipprich, Hendrik Luxenburger, Christoph Neumann-Haefelin, Arthur Schmidt, Christian Jansen, Carsten Meyer, Frank E. Uschner, Maximilian J. Brol, Jonel Trebicka, Martin Rössle, Robert Thimme, Michael Schultheiss |
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| 245 | 1 | 0 | |a Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival |c Dominik Bettinger, Lukas Sturm, Lena Pfaff, Felix Hahn, Roman Kloeckner, Lara Volkwein, Michael Praktiknjo, Yong Lv, Guohong Han, Jan Patrick Huber, Tobias Boettler, Marlene Reincke, Christoph Klinger, Karel Caca, Hauke Heinzow, Leon Louis Seifert, Karl Heinz Weiss, Christian Rupp, Felix Piecha, Johannes Kluwe, Alexander Zipprich, Hendrik Luxenburger, Christoph Neumann-Haefelin, Arthur Schmidt, Christian Jansen, Carsten Meyer, Frank E. Uschner, Maximilian J. Brol, Jonel Trebicka, Martin Rössle, Robert Thimme, Michael Schultheiss |
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| 520 | |a 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. | ||
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