Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival
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Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. / 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.
in: J HEPATOL, Jahrgang 74, Nr. 6, 06.2021, S. 1362-1372.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival
AU - Bettinger, Dominik
AU - Sturm, Lukas
AU - Pfaff, Lena
AU - Hahn, Felix
AU - Kloeckner, Roman
AU - Volkwein, Lara
AU - Praktiknjo, Michael
AU - Lv, Yong
AU - Han, Guohong
AU - Huber, Jan Patrick
AU - Boettler, Tobias
AU - Reincke, Marlene
AU - Klinger, Christoph
AU - Caca, Karel
AU - Heinzow, Hauke
AU - Seifert, Leon Louis
AU - Weiss, Karl Heinz
AU - Rupp, Christian
AU - Piecha, Felix
AU - Kluwe, Johannes
AU - Zipprich, Alexander
AU - Luxenburger, Hendrik
AU - Neumann-Haefelin, Christoph
AU - Schmidt, Arthur
AU - Jansen, Christian
AU - Meyer, Carsten
AU - Uschner, Frank E
AU - Brol, Maximilian J
AU - Trebicka, Jonel
AU - Rössle, Martin
AU - Thimme, Robert
AU - Schultheiss, Michael
N1 - Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - 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.
AB - 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.
U2 - 10.1016/j.jhep.2021.01.023
DO - 10.1016/j.jhep.2021.01.023
M3 - SCORING: Journal article
C2 - 33508376
VL - 74
SP - 1362
EP - 1372
JO - J HEPATOL
JF - J HEPATOL
SN - 0168-8278
IS - 6
ER -