Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Dig Dis Sci. 2022 Sep;67(9):4581-4589. doi: 10.1007/s10620-021-07307-5. Epub 2021 Nov 19.
The Freiburg index of post-TIPS survival (FIPS) score was recently demonstrated to improve prediction of post-TIPS mortality relative to existing standards. As this score was derived from a German cohort over an extended time period, it is unclear if performance will translate well to other settings. This study aimed to externally validate the FIPS score in a large Veterans Affairs (VA) cohort over two separate eras of TIPS-related care.
This was a retrospective cohort study of patients with cirrhosis who underwent TIPS placement in the VA from 2008 to 2020. Cox regression models for post-TIPS survival were constructed using FIPS, MELD, MELD-Na, or CTP scores as predictors. Discrimination (Harrell's C) and calibration (joint tests of calibration curve slope and intercept) were evaluated for each score. A stratified analysis was performed for time periods between 2008-2013 and 2014-2020.
The cohort of 1,274 patients was 97.3% male with mean age 60.9 years and mean MELD-Na 14. The FIPS score demonstrated the highest overall discrimination versus MELD, MELD-Na, and CTP (0.634 vs. 0.585, 0.626, 0.612, respectively). However, in the modern treatment era (2014-2020), the FIPS score performed similarly to MELD-Na. Additionally, the FIPS score demonstrated poor calibration at one-month and six-month post-TIPS timepoints (joint p = 0.04 and 0.004, respectively). MELD, MELD-Na, and CTP were well-calibrated at each timepoint (each joint p > 0.05).
The FIPS score performed similarly to MELD-Na in the modern TIPS treatment era and demonstrated regions of poor calibration. Future models derived with contemporary data may improve prediction of post-TIPS mortality.
弗赖堡经颈静脉肝内门体分流术（TIPS）后生存指数（FIPS）评分最近被证明可提高 TIPS 术后死亡率的预测能力，优于现有标准。由于该评分是从德国队列在较长时间内得出的，因此尚不清楚其在其他环境中的表现是否会很好。本研究旨在通过 VA 两个不同 TIPS 相关治疗时期的大型队列来对 FIPS 评分进行外部验证。
这是一项回顾性队列研究，纳入了 2008 年至 2020 年期间在 VA 接受 TIPS 治疗的肝硬化患者。使用 FIPS、MELD、MELD-Na 或 CTP 评分作为预测因素，构建 TIPS 术后生存的 Cox 回归模型。评估每个评分的区分度（哈雷尔 C 指数）和校准度（校准曲线斜率和截距的联合检验）。对 2008-2013 年和 2014-2020 年两个时间段进行分层分析。
队列中的 1274 名患者均为男性，占 97.3%，平均年龄为 60.9 岁，平均 MELD-Na 为 14。FIPS 评分在 MELD、MELD-Na 和 CTP 评分中表现出最高的总体区分度（0.634 比 0.585、0.626、0.612）。然而，在现代治疗时期（2014-2020 年），FIPS 评分与 MELD-Na 表现相似。此外，FIPS 评分在 TIPS 术后 1 个月和 6 个月时的校准效果较差（联合 p=0.04 和 0.004）。MELD、MELD-Na 和 CTP 在每个时间点的校准效果都很好（每个联合 p>0.05）。
在现代 TIPS 治疗时代，FIPS 评分与 MELD-Na 表现相似，并显示出校准效果不佳的区域。使用当代数据得出的未来模型可能会提高 TIPS 术后死亡率的预测能力。
