1120 Assessment of Risk Factors for Mortality With TIPS Placement: Age or Frailty

Abstract

INTRODUCTION: The Model for End-stage Liver Disease (MELD) score is used for prediction of mortality in cirrhotics undergoing :following transjugular intrahepatic portosystemic shunt (TIPS) placement. Our recent work showed that frailty (measured by psoas muscle density) is associated with increased risk of mortality. Purpose: We performed a post hoc analysis to examine the association of age on mortality in cirrhotics undergoing TIPS placement as there is a tendency to avoid TIPS in older patients with limited data to guide the decision making. METHODS: This a retrospective study encompassing 241 patients with cirrhosis who underwent TIPS placement. The patients had two main indications for TIPS placement, variceal bleeding (VB; n = 113) and volume overload (VO; n = 128). The study included 149 men (62%), and mean patient age was 56 years ± 9.6 (range 24–83). Mean MELD score before TIPS creation was 11.8 ± 5.7. Frailty was assessed by measuring psoas muscle density (PD). A threshold sensitivity of pre-TIPS PD for the assessment of mortality was calculated and then correlated with survival after TIPS creation. RESULTS: Mean follow up duration was 29.9 month ± 34.1 (range 1–3700 days). The increase in MELD score after TIPS creation was significant in both groups (VB, P = .0013; VO, P < .0001). The threshold of pre-TIPS PD for discrimination of survival was 29.4 HU (P < .0001), and PD measurements greater than this threshold were associated with a lower risk of mortality (HR: 0.27; 95% confidence interval, 0.13–0.57; P = 0.0006). Conversely, age was not associated with mortality (P = 0.2461). CONCLUSION: High MELD score and frailty (determined by PD), not age, are associated with mortality in cirrhotic patients undergoing TIPS placement. Further studies are needed to confirm our findings.