Bettinger Dominik, Sturm Lukas, Pfaff Lena, Hahn Felix, Kloeckner Roman, Volkwein Lara, Praktiknjo Michael, Lv Yong, Han Guohong, Huber Jan Patrick, Boettler Tobias, Reincke Marlene, Klinger Christoph, Caca Karel, Heinzow Hauke, Seifert Leon Louis, Weiss Karl Heinz, Rupp Christian, Piecha Felix, Kluwe Johannes, Zipprich Alexander, Luxenburger Hendrik, Neumann-Haefelin Christoph, Schmidt Arthur, Jansen Christian, Meyer Carsten, Uschner Frank E, Brol Maximilian J, Trebicka Jonel, Rössle Martin, Thimme Robert, Schultheiss Michael
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.
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.
J Hepatol. 2021 Jun;74(6):1362-1372. doi: 10.1016/j.jhep.2021.01.023. Epub 2021 Jan 26.
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.
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.
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.
The FIPS score is superior to established scoring systems for the identification of high-risk patients with a worse prognosis following elective TIPS implantation.
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.
经颈静脉肝内门体分流术（TIPS）植入术是治疗门静脉高压并发症的一种安全有效的方法。由于这些患者构成了高危人群，生存预测在他们中很重要。因此，我们研究的目的是开发一种替代的预后模型，用于准确预测计划进行TIPS植入术后的生存情况。
回顾性招募了总共1871例因腹水或二级预防静脉曲张出血而进行初次TIPS植入的患者。研究队列分为训练集（80%的研究患者；n = 1496）和验证集（20%的研究患者；n = 375）。此外，因静脉曲张出血而进行早期（预防性）TIPS植入的患者被纳入另一个验证队列（n = 290）。评估了医疗数据和总生存期（OS）。使用Cox回归模型创建了一个替代预测模型，该模型包括显著的预后因素。
年龄、胆红素、白蛋白和肌酐是最重要的预后因素。这些参数被纳入一个名为TIPS术后生存的弗莱堡指数（FIPS）的新评分中。FIPS评分能够识别高危患者，在训练集中，TIPS植入术后这些患者的中位生存期显著缩短至5.0（3.1 - 6.9）个月。这些结果在验证集中得到了证实（中位生存期为3.1 [0.9 - 5.3]个月）。与Child-Pugh、MELD、MELD-Na评分和胆红素-血小板模型相比，FIPS评分显示出更好的预后判别能力。然而，FIPS评分在早期进行TIPS植入的患者中显示出不足的预后判别能力。
对于识别择期TIPS植入术后预后较差的高危患者，FIPS评分优于已建立的评分系统。
经颈静脉肝内门体分流术（TIPS）植入术对于肝硬化和具有临床意义的门静脉高压患者是一种安全有效的治疗方法。然而，风险分层是这些患者面临的一项重大挑战，因为目前可用的评分系统存在重大缺陷。年龄、胆红素、白蛋白和肌酐被纳入一个新的风险评分，该评分被命名为TIPS术后生存的弗莱堡指数（FIPS）。FIPS评分可以识别高危患者，并可能指导临床决策。
