Abstract
Introduction: Transjugular intrahepatic portosystemic stent-shunt (TIPS) is increasingly used for portal decompression. However, despite effective variceal bleeding control, cirrhotic patients with multiorgan dysfunctionfailure (MODF) prior to TIPS might have a higher risk of early-mortality (EM: 60 days). Methods: Although the APACHE-II (AP-II) score is established for MODF assessment, it is actually not validated for patients with liver cirrhosis and it is rather complicated, which limits its clinical availability. We compared the AP-II data with that of an easier clinical-bedside-score (CBS) as earlymortality predictor in a cohort of 103 consecutive TIPS patients (Child-Pugh: 24x A, 52x B, 27x C). The CBS simply adds actually the absence (= 0 P) or the presence (= 1 P) of four symptoms: (1) systemic infection (fever or signs of sepsis), (2) impaired systemic circulation (systolic blood pressure: 1.5 mg/dl). Results: TIPS insertion was successful in 101/103 patients (98%) with a periinterventional mortality rate of 2% (2/103). Within 60 days after TIPS we saw 15 deaths (EM=15%). The risk of EM increased in parallel to the degree of MODF as assesed by AP-II and CBS. The two MODF scores correlated significantly (r=0.8; p<0.001) and both scores provided a similar prognostic grading in low, medium and high earlymortality (EM) risk groups (p<0.0001, see Table):
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