Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China (B.X., X.W.).
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (C.Y.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (C.Y., C.Z., S.H.).
Acad Radiol. 2023 Sep;30 Suppl 1:S246-S256. doi: 10.1016/j.acra.2023.03.011. Epub 2023 Apr 5.
Multiple prognostic scores have been applied for predicting survival after TIPS placement. The aim was to evaluate the added value of sarcopenia on existing risk scores and develop a sarcopenia-based scoring system for survival prediction and risk stratification.
In the derivation cohort of 386 cirrhotic patients undergoing TIPS, five risk scores (Child-Pugh, MELD, MELD-Na, MELD 3.0, and FIPS) were compared for prediction of short- and long-term mortality after TIPS. Sarcopenia was diagnosed based on the L3 skeletal muscle index and was incorporated into existing scores to assess its added value. A novel sarcopenia-based score was developed and externally validated in an independent cohort of 198 patients undergoing TIPS.
Among existing scores, the FIPS score showed the highest discrimination (c-index: 0.756-0.783) and calibration (Brier score: 0.059-0.127). Besides, the FIPS score was significantly associated with the severity of baseline sarcopenia and reversal of sarcopenia after TIPS. The inclusion of sarcopenia improved discrimination of existing scores in different degrees and sarcopenia could stratify the low-risk categories deemed by these scores. A FIPS-sarcopenia score was developed, showing superior discrimination over existing scores (c-index: 0.777-0.804 in the derivation cohort, 0.738-0.788 in the validation cohort). With a determined cutoff of 0.8, this score allowed for the identification of two prognostic subgroups with distinct prognoses.
FIPS score was highly correlated with the severity of sarcopenia and sarcopenia reversal after TIPS, and sarcopenia could improve the prognostic ability of existing scores. A FIPS-sarcopenia score was developed and validated, showing improved survival prediction and risk stratification.
已有多种预后评分用于预测 TIPS 术后的生存情况。本研究旨在评估肌少症对现有风险评分的附加价值，并开发一种基于肌少症的评分系统用于生存预测和风险分层。
在接受 TIPS 治疗的 386 例肝硬化患者的推导队列中，比较了五个风险评分（Child-Pugh、MELD、MELD-Na、MELD3.0 和 FIPS）在预测 TIPS 术后短期和长期死亡率方面的作用。根据 L3 骨骼肌指数诊断肌少症，并将其纳入现有评分以评估其附加价值。在接受 TIPS 治疗的 198 例独立患者的队列中，开发并外部验证了一种新的基于肌少症的评分。
在现有的评分中，FIPS 评分显示出最高的区分度（c 指数：0.756-0.783）和校准度（Brier 评分：0.059-0.127）。此外，FIPS 评分与基线肌少症的严重程度以及 TIPS 后肌少症的逆转显著相关。肌少症的纳入在不同程度上提高了现有评分的区分度，肌少症可以对这些评分认为的低危类别进行分层。开发了 FIPS-肌少症评分，在推导队列中显示出优于现有评分的区分度（c 指数：0.777-0.804），在验证队列中也具有相似的表现（c 指数：0.738-0.788）。在确定的截断值为 0.8 时，该评分可以将两个具有不同预后的预后亚组区分开来。
FIPS 评分与 TIPS 后肌少症的严重程度和逆转程度高度相关，肌少症可以提高现有评分的预后能力。开发并验证了一种 FIPS-肌少症评分，显示出改善的生存预测和风险分层能力。
