Top

Digestive Diseases and Sciences

Published in:

19-11-2021 | Original Article

External Validation of the FIPS Score for Post-TIPS Mortality in a National Veterans Affairs Cohort

Authors: Sara E. Chapin, David S. Goldberg, David E. Kaplan, Nadim Mahmud

Published in: Digestive Diseases and Sciences | Issue 9/2022

Abstract

Background

The Freiburg index of post-TIPS survival (FIPS) score was recently demonstrated to improve prediction of post-TIPS mortality relative to existing standards. As this score was derived from a German cohort over an extended time period, it is unclear if performance will translate well to other settings. This study aimed to externally validate the FIPS score in a large Veterans Affairs (VA) cohort over two separate eras of TIPS-related care.

Methods

This was a retrospective cohort study of patients with cirrhosis who underwent TIPS placement in the VA from 2008 to 2020. Cox regression models for post-TIPS survival were constructed using FIPS, MELD, MELD-Na, or CTP scores as predictors. Discrimination (Harrell’s C) and calibration (joint tests of calibration curve slope and intercept) were evaluated for each score. A stratified analysis was performed for time periods between 2008–2013 and 2014–2020.

Results

The cohort of 1,274 patients was 97.3% male with mean age 60.9 years and mean MELD-Na 14. The FIPS score demonstrated the highest overall discrimination versus MELD, MELD-Na, and CTP (0.634 vs. 0.585, 0.626, 0.612, respectively). However, in the modern treatment era (2014–2020), the FIPS score performed similarly to MELD-Na. Additionally, the FIPS score demonstrated poor calibration at one-month and six-month post-TIPS timepoints (joint p = 0.04 and 0.004, respectively). MELD, MELD-Na, and CTP were well-calibrated at each timepoint (each joint p > 0.05).

Conclusion

The FIPS score performed similarly to MELD-Na in the modern TIPS treatment era and demonstrated regions of poor calibration. Future models derived with contemporary data may improve prediction of post-TIPS mortality.

Available only for authorised users

Boyer TD, Haskal ZJ. The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: Update 2009. Hepatology. 2010. https://doi.org/10.1002/hep.23383.CrossRefPubMed

Rajesh S, George T, Abby Philips C et al. World Journal of Gastroenterology Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update Conflict-of-interest statement. World J Gastroenterol. 2020;26:5561–5596. https://doi.org/10.3748/wjg.v26.i37.5561.CrossRefPubMedPubMedCentral

Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PCJ. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemicshunts. Hepatology. 2000;31:864–871. https://doi.org/10.1053/he.2000.5852.CrossRefPubMed

Young S, Rostambeigi N, Golzarian J, Lim N. MELD or sodium MELD: A comparison of the ability of two scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt placement. AJR AM J Roentgenol. 2020;215:215–222. https://doi.org/10.2214/AJR.19.21726.CrossRefPubMed

Lee BT, Yang AH, Urban S et al. Applying the original model for end-stage liver disease score rather than the model for end-stage liver disease-Na score for risk stratification prior to transjugular intrahepatic portosystemic shunt procedures. Eur J of Gastroenterol Hepatol. 2021;33:541–546. https://doi.org/10.1097/MEG.0000000000001760.CrossRef

Bureau C, Métivier S, D’Amico M et al. Serum bilirubin and platelet count: A simple predictive model for survival in patients with refractory ascites treated by TIPS. J Hepatol. 2011;54:901–907. https://doi.org/10.1016/j.jhep.2010.08.025.CrossRefPubMed

Bettinger D, Sturm L, Pfaff L et al. Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival. J Hepatol. 2021. https://doi.org/10.1016/j.jhep.2021.01.023.CrossRefPubMed

Kaplan DE, Dai F, Aytaman A et al. Development and Performance of an Algorithm to Estimate the Child-Turcotte-Pugh Score From a National Electronic Healthcare Database. Clinical Gastroenterology and Hepatology. 2015. https://doi.org/10.1016/j.cgh.2015.07.010.CrossRefPubMedPubMedCentral

Mahmud N, Hubbard RA, Kaplan DE, Taddei TH, Goldberg DS. Risk prediction scores for acute on chronic liver failure development and mortality. Liver International. 2020. https://doi.org/10.1111/liv.14328.CrossRefPubMed

10.

Lapointe-Shaw L, Georgie F, Carlone D et al. Identifying cirrhosis, decompensated cirrhosis and hepatocellular carcinoma in health administrative data: a validation study. Published online. 2018. https://doi.org/10.1371/journal.pone.0201120.CrossRef

11.

Mahmud N, Kaplan DE, Taddei TH, Goldberg DS. Incidence and mortality of acute-on-chronic liver failure using two definitions in patients with compensated cirrhosis. Hepatology. 2019. https://doi.org/10.1002/hep.30494.CrossRefPubMed

12.

Beste LA, Leipertz SL, Green PK, Dominitz JA, Ross D, Ioannou GN. Trends in Burden of Cirrhosis and Hepatocellular Carcinoma by Underlying Liver Disease in US Veterans, 2001–2013. Gastroenterology. 2015. https://doi.org/10.1053/j.gastro.2015.07.056.CrossRefPubMed

13.

Re VL, Lim JK, Goetz MB et al. Validity of diagnostic codes and liver-related laboratory abnormalities to identify hepatic decompensation events in the Veterans Aging Cohort Study. Pharmacoepidemiology and Drug Safety. 2011. https://doi.org/10.1002/pds.2148.CrossRefPubMedPubMedCentral

14.

Sohn M-W, Arnold N, Maynard C, Hynes DM. Accuracy and completeness of mortality data in the Department of Veterans Affairs. Popul Health Metr. 2006. https://doi.org/10.1186/1478-7954-4-2.CrossRefPubMedPubMedCentral

15.

Moons KGM, Altman DG, Reitsma JB et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): Explanation and Elaboration. Ann Intern Med. 2015;162:1–73. https://doi.org/10.7326/M14-0698.CrossRef

16.

Khabbaz RC, Lokken RP, Chen YF et al. Albumin-Bilirubin and Platelet–Albumin–Bilirubin Grades Do Not Predict Survival After Transjugular Intrahepatic Portosystemic Shunt Creation. Cardiovas Intervent Radiol. 2018;41:1029–1034. https://doi.org/10.1007/s00270-018-1923-2.CrossRef

17.

Schepke M, Roth F, Fimmers R et al. Comparison of MELD, Child-Pugh, and Emory Model for the Prediction of Survival in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunting. AM J Gastroenterol. 2003;98:1167–1174. https://doi.org/10.1016/S0002-9270(03)00295-8.CrossRefPubMed

18.

Angermayr B, Cejna M, Karnel F et al. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut. 2003;52:879–885. https://doi.org/10.1136/gut.52.6.879.CrossRefPubMedPubMedCentral

19.

Salerno F, Merli M, Cazzaniga M, et al MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36(4):494–500. www.elsevier.com/locate/jhep

20.

Zhou C, Hou C, Cheng D, Tang W, Lv W. Predictive accuracy comparison of MELD and Child-Turcotte-Pugh scores for survival in patients underwent TIPS placement: a systematic meta-analytic review. Int J Clin Exp Med. 2015;8(8):13464–13472. www.ijcem.com/

21.

Kraglund F, Gantzel RH, Jepsen P, Aagaard NK. External validation of the Freiburg index of post-TIPS survival. Journal of Hepatology. 2021. https://doi.org/10.1016/j.jhep.2021.04.027.CrossRefPubMed

22.

Angermayr B, Cejna M, Koenig F et al. Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE-covered stentgrafts versus bare stents. Hepatology. 2003;38:1043–1050. https://doi.org/10.1053/jhep.2003.50423.CrossRefPubMed

23.

Bureau C, Garcia-Pagan JC, Otal P et al. Improved Clinical Outcome Using Polytetrafluoroethylene-Coated Stents for TIPS: Results of a Randomized Study. Gastroenterology. 2004;126:469–475. https://doi.org/10.1053/j.gastro.2003.11.016.CrossRefPubMed

24.

Bureau C, Thabut D, Oberti F et al. Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites. Gastroenterology. 2017;152:157–163. https://doi.org/10.1053/j.gastro.2016.09.016.CrossRefPubMed

25.

Liu J, Paul Wehrenberg-Klee E, Bethea ED, Uppot RN, Yamada K, Ganguli S. Transjugular Intrahepatic Portosystemic Shunt Placement for Portal Hypertension: Meta-Analysis of Safety and Efficacy of 8mm vs 10mm Stents. Gastroent Res Pract. 2020. https://doi.org/10.1155/2020/9149065.CrossRef

26.

Riggio O, Ridola L, Angeloni S et al. Clinical efficacy of transjugular intrahepatic portosystemic shunt created with covered stents with different diameters: Results of a randomized controlled trial. J Hepatol. 2010. https://doi.org/10.1016/j.jhep.2010.02.033.CrossRefPubMed

27.

Miraglia R, Maruzzelli • Luigi, Ambra •, et al. Transjugular Intrahepatic Portosystemic Shunt Using the New Gore Viatorr Controlled Expansion Endoprosthesis: Prospective, Single-Center, Preliminary Experience. Cardiovasc Intervent Radiol. 2019;42(1):78–86. doi:https://doi.org/10.1007/s00270-018-2040-y

28.

Mollaiyan A, Bettinger D, Rössle M. The underdilation of nitinol stents at TIPS implantation: Solution or illusion? Eur J Radiol. 2017;89:123–128. https://doi.org/10.1016/j.ejrad.2017.01.032.CrossRefPubMed

29.

Vizzutti F, Schepis F, Arena U et al. Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes. Intern Emerg Med. 2020;15:37–48. https://doi.org/10.1007/s11739-019-02252-8.CrossRefPubMed

30.

Rösch J, Hanafee WN, Snow H. Transjugular Portal Venography and Radiologic Portacaval Shunt: An Experimental Study. Radiology. 1969;92:1112–1114. https://doi.org/10.1148/92.5.1112.CrossRefPubMed

31.

Stockhoff L, Schneider H, Tergast TL, Cornberg M, Maasoumy B. Freiburg index of post-TIPS survival (FIPS) a valid prognostic score in patients with cirrhosis but also an advisor against TIPS? Journal of Hepatology. 2021. https://doi.org/10.1016/j.jhep.2021.02.031.CrossRefPubMed

32.

Goldberg DS, French B, Forde KA et al. Association of Distance From a Transplant Center With Access to Waitlist Placement, Receipt of Liver Transplantation, and Survival Among US Veterans. JAMA. 2014. https://doi.org/10.1001/jama.2014.2520.CrossRefPubMedPubMedCentral

33.

Julapalli VR, Kramer JR, El-Serag HB. Evaluation for Liver Transplantation: Adherence to AASLD Referral Guidelines in a Large Veterans Affairs Center. Published online. 2005. https://doi.org/10.1002/lt.20434.CrossRef

Title: External Validation of the FIPS Score for Post-TIPS Mortality in a National Veterans Affairs Cohort
Authors: Sara E. Chapin
David S. Goldberg
David E. Kaplan
Nadim Mahmud
Publication date: 19-11-2021
Publisher: Springer US
Published in: Digestive Diseases and Sciences / Issue 9/2022
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-021-07307-5

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

External Validation of the FIPS Score for Post-TIPS Mortality in a National Veterans Affairs Cohort

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2022

Bacillus Subtilis Promotes the Release of 5-HT to Regulate Intestinal Peristalsis in STC Mice via Bile Acid and Its Receptor TGR5 Pathway

Risk of Postpartum Flare Hospitalizations in Patients with Inflammatory Bowel Disease Persists After Six Months

Colorectal Cancer Screening and Yield in a Mailed Outreach Program in a Safety-Net Healthcare System

Risk of Stent Migration in Intended Long-Term Biliary Plastic Stents: Is Being Straight Good?

Algorithms to Identify Alcoholic Hepatitis Hospitalizations in Patients with Cirrhosis

DDS Profile: Daniel Hollander, MD

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page