A novel score predicts mortality after transjugular intrahepatic portosystemic shunt: MOTS - Modified TIPS Score.

Abstract

Background and aimsThe high risk for severe shunting‐related post‐interventional complications demands a stringent selection of candidates for transjugular intrahepatic portosystemic shunt (TIPS). We aimed to develop a simple and reliable tool to accurately predict early post‐TIPS mortality.Methods144 cases of TIPS implantation were retrospectively analysed. Using univariate and multivariate Cox regression analysis of factors predicting mortality within 90 days after TIPS, a score integrating urea, international normalized ratio (INR) and bilirubin was developed. The Modified TIPS‐Score (MOTS) ranges from 0 to 3 points: INR >1.6, urea >71 mg/dl and bilirubin >2.2 mg/dl account for one point each. Additionally, MOTS was tested in an external validation cohort (n = 187) and its performance was compared to existing models.ResultsModified TIPS‐Score achieved a significant prognostic discrimination reflected by 90‐day mortality of 8% in patients with MOTS 0–1 and 60% in patients with MOTS 2–3 (p < .001). Predictive performance (area under the curve) of MOTS was accurate (c = 0.845 [0.73–0.96], p < .001), also in patients with renal insufficiency (c = 0.830 [0.64–1.00], p = .02) and in patients with refractory ascites (c = 0.949 [0.88–1.00], p < .001), which are subgroups with particular room for improvement of post‐TIPS mortality prediction. The results were reproducible in the validation cohort.ConclusionsModified TIPS‐Score is a novel, practicable tool to predict post‐TIPS mortality, that can significantly simplify clinical decision making. Its practical applicability should be further investigated.