Z Gastroenterol 2022; 60(08): e469
DOI: 10.1055/s-0042-1754703
Abstracts | DGVS/DGAV
Leber und Galle
Portale Hypertension
Freitag, 16. September 2022, 15:55 – 17:07, Saal 8

Risk assessment in TIPS patients: reassessment after TIPS implantation recommended

LL Seifert
1   University Hospital Muenster, Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectious Disease, Muenster, Deutschland
,
A Appelhans
1   University Hospital Muenster, Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectious Disease, Muenster, Deutschland
,
P Schindler
2   University Hospital Muenster, Clinic for Radiology, Muenster, Deutschland
,
M Wildgruber
3   University Hospital LMU Munich, Department of Radiology, Munich, Deutschland
,
A Hüsing-Kabar
1   University Hospital Muenster, Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectious Disease, Muenster, Deutschland
,
H Heinzow
4   Krankenhaus der Barmherzigen Brüder, Department of Medicine I, Trier, Deutschland
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
 

Background Risk assessment in TIPS patients is performed before TIPS implantation for patient selection. Several risk scores and cut-off values have been proposed to identify high-risk (HR) patients after TIPS. Additional risk assessment after TIPS implantation may improve identification of patients at risk of acute-on-chronic liver failure (ACLF) or impaired transplant-free survival (TFS).

Aim The aim of this study was to compare the predictive potential of pre- and post- MELD, MELD-sodium and FIPS-scores for ACLF and TFS after TIPS implantation and identify HR patients.

Methods A retrospective analysis of 245 TIPS patients with variceal bleeding or ascites was performed. All patients receiving emergency TIPS or preemptive TIPS for variceal bleeding were excluded from the final analysis. Model-of-End-stage-Liver-Disease (MELD)-score, MELD-sodium score and FreiburgIndex-of-Post-TIPS-Survival (FIPS)-score were assessed at 3 (1-5) days before (preMELD, preMELDsodium, preFIPS) and 5 (3-7 days) post TIPS (postMELD, postMELD-sodium, postFIPS).

Results AUROC for prediction both of ACLF and TFS was superior if performed after TIPS insertion. AUROCs for ACLF [pre vs. post]: MELD 0.736 vs. 0.784, MELD-sodium 0.771 vs. 0.832, FIPS 0.637 vs. 0.655. AUROCs for TFS: MELD 0.612 vs. 0.624, MELD-sodium 0.691 vs. 0.725, FIPS 0.637 vs. 0.655. The 85th percentile was defined as the cut-off value to distinguish between patients with high-risk (HR) and low-risk (LR) of death or LT after TIPS. postMELD, postMELD-sodium and postFIPS performed superior in the identification of HR patients after TIPS (preMELD [HR vs LR]: 41.5% vs 63.7% TFS after 12 months, p=0.007; postMELD: 30.8% vs. 65.5%, p<0.001. preMELD-sodium: 40.5% vs 64.0%, p=0.005; postMELD-sodium: 27.0% vs 65.9%, p<0.001. preFIPS: 32.0% vs. 63.2%, p=0.003; postFIPS: 22.6% vs. 65.4%, p<0.001).

Conclusion Risk assessment before TIPS implantation is important for careful patient selection. Nonetheless, risk assessment should be repeated shortly after TIPS implantation to improve identification of patients at high risk for development of ACLF or impaired TFS. Post-TIPS follow up should be intensified in HR patients.



Publikationsverlauf

Artikel online veröffentlicht:
19. August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany