Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Fuerschuss, L.
A novel score to predict mortality after transjugular intrahepatic portosystemic shunt (TIPS).
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2020. pp. 98
[OPEN ACCESS]
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Rainer Florian
- Stadlbauer-Köllner Vanessa
- Altmetrics:
- Abstract:
- Background: Transjugular intrahepatic portosystemic shunt (TIPS) has been shown as an effective treatment of portal hypertension-related complications with beneficial effects on morbidity and mortality in selected patients. However, severe complications, such as post-TIPS HE and acute on chronic hepatic failure demand for optimal selection of candidates. Of the various risk-stratification tools that have been published, the Model of End-Stage Liver Disease (MELD) is the so far best validated model to predict post-TIPS mortality. Methods: Utilizing data from 158 cases of TIPS placement between 01/2004 and 12/2017 at the University Hospital Graz, we aimed to develop a mortality-predicting tool with beneficial features compared to MELD. Results: 144 patients were included in the analysis. Univariate and multivariate analyses of factors predicting mortality within 90 days were performed and a score integrating urea, INR and bilirubin was developed. Modified TIPS-Score (MOTS) ranges from 0-3 points: INR >1.6, urea >71 mg/dl and bilirubin >2.2 mg/dl imply plus one point each. 90-day mortality rates were 4%, 13%, 50% and 75% in patients with MOTS 0 points (n=50), 1 point (n=40), 2 points (n=12) and 3 points (n=8), respectively (p<0.001). Within the total cohort, the predictive performance of MOTS and MELD was similar (AUROC statistics; MOTS: 0.85 [95% CI: 0.74-0.96]; MELD 0.84; [0.74-0.96]. However, in patients with renal insufficiency (eGFR <60, n=31), MOTS predicted mortality with higher accuracy than MELD (MOTS: 0.85; [0.68-1.00]; MELD: 0.77 [0.57-0.97]). The results were validated in an external cohort from the University Hospital Innsbruck. Conclusion: With the simple MOTS, we developed a valuable tool to predict post-TIPS mortality, with higher accuracy than MELD in patients with eGFR <60. To optimize future patient selection, prospective validation of MOTS is crucial.