Department of Medicine IIMedical Center University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany.
Berta-Ottenstein-ProgrammeFaculty of MedicineUniversity of FreiburgFreiburgGermany.
Hepatol Commun. 2021 Jan 5;5(4):650-660. doi: 10.1002/hep4.1654. eCollection 2021 Apr.
Prognostic assessment of patients with liver cirrhosis allocated for implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a challenging task in clinical practice. The aim of our study was to assess the prognostic value of the CLIF-C AD (Acute Decompensation) score in patients with TIPS implantation. Transplant-free survival (TFS) and 3-month mortality were reviewed in 880 patients who received TIPS implantation for the treatment of cirrhotic portal hypertension. The prognostic value of the CLIF-C AD score was compared with the Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, and albumin-bilirubin (ALBI) score using Harrell's C concordance index. The median TFS after TIPS implantation was 40.0 (34.6-45.4) months. The CLIF-C AD score (c = 0.635 [0.609-0.661]) was superior in the prediction of TFS in comparison to MELD score (c = 0.597 [0.570-0.623], = 0.006), Child-Pugh score (c = 0.579 [0.552-0.606], < 0.001), and ALBI score (c = 0.573 [0.545-0.600], < 0.001). However, the CLIF-C AD score did not perform significantly better than the MELD-Na score (c = 0.626 [0.599-0.653], = 0.442). There were no profound differences in the scores' ranking with respect to indication for TIPS implantation, stent type, or underlying liver disease. Subgroup analyses revealed that a CLIF-C AD score >45 was a predictor of 3-month mortality in the supposed low-risk group of patients with a MELD score ≤12 (14.7% vs. 5.1%, < 0.001). The CLIF-C AD score is suitable for prognostic assessment of patients with cirrhotic portal hypertension receiving TIPS implantation. In the prediction of TFS, the CLIF-C AD score is superior to MELD score, Child-Pugh score, and ALBI score but not the MELD-Na score.
对于接受经颈静脉肝内门体分流术（TIPS）植入的肝硬化患者的预后评估是临床实践中的一项具有挑战性的任务。我们的研究旨在评估 CLIF-C AD（急性失代偿）评分在 TIPS 植入患者中的预后价值。回顾了 880 名接受 TIPS 植入治疗肝硬化门静脉高压的患者的无移植生存率（TFS）和 3 个月死亡率。使用 Harrell 的 C 一致性指数比较了 CLIF-C AD 评分与终末期肝病模型（MELD）评分、Child-Pugh 评分和白蛋白-胆红素（ALBI）评分的预后价值。TIPS 植入后的中位 TFS 为 40.0（34.6-45.4）个月。CLIF-C AD 评分（c=0.635 [0.609-0.661]）在预测 TFS 方面优于 MELD 评分（c=0.597 [0.570-0.623]， =0.006）、Child-Pugh 评分（c=0.579 [0.552-0.606]， <0.001）和 ALBI 评分（c=0.573 [0.545-0.600]， <0.001）。然而，CLIF-C AD 评分与 MELD-Na 评分（c=0.626 [0.599-0.653]， =0.442）相比，表现并不显著更好。在 TIPS 植入适应证、支架类型或基础肝病方面，各评分的排序没有明显差异。亚组分析显示，在 MELD 评分≤12 的低危患者中，CLIF-C AD 评分>45 是 3 个月死亡率的预测因素（14.7%比 5.1%， <0.001）。CLIF-C AD 评分适用于接受 TIPS 植入的肝硬化门静脉高压患者的预后评估。在预测 TFS 方面，CLIF-C AD 评分优于 MELD 评分、Child-Pugh 评分和 ALBI 评分，但不如 MELD-Na 评分。
