Dominik Bettinger1, Lukas Sturm2, Lena Pfaff3, Felix Hahn4, Roman Kloeckner4, Lara Volkwein3, Michael Praktiknjo5, Yong Lv6, Guohong Han7, Jan Patrick Huber3, Tobias Boettler2, Marlene Reincke3, Christoph Klinger8, Karel Caca8, Hauke Heinzow9, Leon Louis Seifert9, Karl Heinz Weiss10, Christian Rupp11, Felix Piecha12, Johannes Kluwe12, Alexander Zipprich13, Hendrik Luxenburger14, Christoph Neumann-Haefelin3, Arthur Schmidt3, Christian Jansen5, Carsten Meyer15, Frank E Uschner16, Maximilian J Brol5, Jonel Trebicka17, Martin Rössle18, Robert Thimme3, Michael Schultheiss3. 1. 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. 2. 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. 3. Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany. 4. Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. 5. Department of Internal Medicine I, University of Bonn, Bonn, Germany. 6. 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. 7. 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. 8. Department of Gastroenterology, Hepatology and Oncology, Hospital of Ludwigsburg, Germany. 9. Department of Gastroenterology and Hepatology, University Hospital Münster, Germany. 10. Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany; Krankenhaus Salem der evang, Stadtmission Heidelberg, Heidelberg, Germany. 11. Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany. 12. I. Department of Medicine University Medical Center Hamburg-Eppendorf Hamburg, Germany. 13. Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Halle, Germany. 14. 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. 15. Department of Radiology, University Hospital Bonn, Bonn, Germany. 16. Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany. 17. Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain. 18. 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.
Abstract
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.
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.
Authors: Leon Louis Seifert; Philipp Schindler; Lukas Sturm; Wenyi Gu; Quentin Edward Seifert; Jan Frederic Weller; Christian Jansen; Michael Praktiknjo; Carsten Meyer; Martin Schoster; Christian Wilms; Miriam Maschmeier; Hartmut H Schmidt; Max Masthoff; Michael Köhler; Michael Schultheiss; Jan Patrick Huber; Dominik Bettinger; Jonel Trebicka; Moritz Wildgruber; Hauke Heinzow Journal: Hepatol Int Date: 2022-04-05 Impact factor: 9.029
Authors: Justin Richard Boike; Nikhilesh Ray Mazumder; Kanti Pallav Kolli; Jin Ge; Margarita German; Nathaniel Jest; Giuseppe Morelli; Erin Spengler; Adnan Said; Jennifer C Lai; Archita P Desai; Thomas Couri; Sonali Paul; Catherine Frenette; Elizabeth C Verna; Usman Rahim; Aparna Goel; Dyanna Gregory; Bartley Thornburg; Lisa B VanWagner Journal: Am J Gastroenterol Date: 2021-10-01 Impact factor: 12.045
Authors: Lena Stockhoff; Theresa Muellner-Bucsics; Antoaneta A Markova; Marie Schultalbers; Simone A Keimburg; Tammo L Tergast; Jan B Hinrichs; Nicolas Simon; Svetlana Gerbel; Michael P Manns; Mattias Mandorfer; Markus Cornberg; Bernhard C Meyer; Heiner Wedemeyer; Thomas Reiberger; Benjamin Maasoumy Journal: Hepatol Commun Date: 2021-09-28