Internal medicine journal · 2026
Prognostic scores for early mortality following transjugular intrahepatic portosystemic shunt insertion: external validation in a contemporary Australian cohort.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Walia Nirbaanjot, Nilsen Oliver, Cheung Ernest, Abdelmalak Jonathan, Spurio Jessica, Fernandez Monique, Freeman Thomas, Hey Penelope, Vaz Karl, Sinclair Marie, Majumdar Avik, Testro Adam
Аннотация
BACKGROUND: Mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement remains a critical concern. Traditional scoring systems, such as the Model for End-Stage Liver Disease (MELD) and MELD-Na, as well as the newer Modified TIPS-Score (MOTS) and Freiburg Index of Post-TIPS Survival (FIPS), have shown potential for refining risk stratification.
AIMS: To externally validate prognostic scores for predicting 30- and 90-day mortality following TIPS.
METHODS: This retrospective study, conducted at Austin Health, Australia, included 117 patients who underwent TIPS with ≥90 days of follow-up between 2011 and 2024. Prognostic scores were calculated using pre-TIPS clinical and laboratory data. Discrimination and calibration were assessed and prognostic accuracy evaluated at established thresholds for MELD ≥ 18, MELD-Na ≥ 20, MOTS > 1, FIPS ≥ 0.92 and additional scores.
RESULTS: TIPS indications included ascites and/or hepatic hydrothorax (56.4%), variceal haemorrhage (34.2%), Budd-Chiari syndrome (6.0%) and other indications (3.4%). Mortality occurred in 13 (11.1%) and 21 patients (17.9%) by 30 and 90 days respectively. MELD demonstrated the best discrimination for 30-day mortality (area under the curve (AUC) = 0.82), followed by MOTS (0.80), FIPS (0.76) and MELD-Na (0.73), with similar trends at 90 days. MOTS was best calibrated, followed by FIPS and MELD. FIPS ≥ 0.92 had excellent specificities (94% and 95%) and negative predictive values (94% and 88%) for 30- and 90-day mortality, marginally outperforming MELD and MOTS. MELD-Na and other scores performed less well.
CONCLUSION: MOTS, MELD and FIPS demonstrated robust discriminative performance for early post-TIPS mortality and outperformed other models. Further research is required to establish optimum risk thresholds for these tools and support these findings.
AIMS: To externally validate prognostic scores for predicting 30- and 90-day mortality following TIPS.
METHODS: This retrospective study, conducted at Austin Health, Australia, included 117 patients who underwent TIPS with ≥90 days of follow-up between 2011 and 2024. Prognostic scores were calculated using pre-TIPS clinical and laboratory data. Discrimination and calibration were assessed and prognostic accuracy evaluated at established thresholds for MELD ≥ 18, MELD-Na ≥ 20, MOTS > 1, FIPS ≥ 0.92 and additional scores.
RESULTS: TIPS indications included ascites and/or hepatic hydrothorax (56.4%), variceal haemorrhage (34.2%), Budd-Chiari syndrome (6.0%) and other indications (3.4%). Mortality occurred in 13 (11.1%) and 21 patients (17.9%) by 30 and 90 days respectively. MELD demonstrated the best discrimination for 30-day mortality (area under the curve (AUC) = 0.82), followed by MOTS (0.80), FIPS (0.76) and MELD-Na (0.73), with similar trends at 90 days. MOTS was best calibrated, followed by FIPS and MELD. FIPS ≥ 0.92 had excellent specificities (94% and 95%) and negative predictive values (94% and 88%) for 30- and 90-day mortality, marginally outperforming MELD and MOTS. MELD-Na and other scores performed less well.
CONCLUSION: MOTS, MELD and FIPS demonstrated robust discriminative performance for early post-TIPS mortality and outperformed other models. Further research is required to establish optimum risk thresholds for these tools and support these findings.