Abstract
Background and AimSeveral models have been developed to predict survival in patients with cirrhosis undergoing TIPS; however, few of these models have gained widespread acceptance, especially in the era of covered stents. The aim of this study was to establish an evidence-based model for predicting survival after TIPS procedures.MethodsA total of 210 patients with cirrhosis treated with TIPS were considered in the study. We comprehensively investigated factors associated with one-year survival and developed a new predictive model using the Cox regression model.ResultsIn the multivariate analysis, the Child-Pugh score and serum sodium levels were independent predictors of one-year survival. A new score incorporating serum sodium into the Child-Pugh score was developed: Child-Na score. We compared the predictive accuracy of Child-Na score with that of other scores; only the Child-Na and MELD-Na scores had adequate predictive ability in patients with serum Na levels <138 mmol/L. The best Child-Na cut-off score (15.5) differentiated two groups of patients with distinct prognoses (one-year cumulative survival rates of 80.6% and 45.5%); this finding was confirmed in a validation cohort (n = 86). In a subgroup analysis stratifying patients by indication for TIPS, the Child-Na score distinguished patients with different prognoses.ConclusionsPatients with variceal bleeding and a Child-Na score ≤15 had a better prognosis than patients with a score ≥16. Patients with refractory ascites and a Child-Na score ≥16 had a high risk of death after the TIPS procedures; caution should be used when treating these patients with TIPS.
Highlights
The transjugular intrahepatic portosystemic shunt (TIPS) procedure is increasingly used to treat the complications of portal hypertension
The major drawback of TIPS is the potential occurrence of shunt dysfunction and hepatic encephalopathy (HE)
The use of expanded polytetrafluoroethylene-covered stent-grafts has overcome the problem of post-TIPS shunt insufficiency [2], and the 2009 update of the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines states that ‘‘the use of ePTFE-covered stents is preferred’’ [3]
Summary
The transjugular intrahepatic portosystemic shunt (TIPS) procedure is increasingly used to treat the complications of portal hypertension. The use of expanded polytetrafluoroethylene (ePTFE)-covered stent-grafts has overcome the problem of post-TIPS shunt insufficiency [2], and the 2009 update of the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines states that ‘‘the use of ePTFE-covered stents is preferred’’ [3]. The one-year mortality rate following TIPS with the use of covered stents is partially dependent on the indication for the procedure, and mortality has been found to range from 10-35% [4,5,6,7,8,9,10,11]. Several models have been developed to predict survival in patients with cirrhosis undergoing TIPS; few of these models have gained widespread acceptance, especially in the era of covered stents. The aim of this study was to establish an evidence-based model for predicting survival after TIPS procedures
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