Z Gastroenterol 2020; 58(05): e102
DOI: 10.1055/s-0040-1712320
Hepatologie

A novel score to predict mortality after transjugular intrahepatic portosystemic shunt in patients with renal insufficiency

L Fürschuß
1   Klinische Abteilung für Gastroenterologie und Hepatologie, Graz, Austria
,
F Rainer
1   Klinische Abteilung für Gastroenterologie und Hepatologie, Graz, Austria
,
M Effenberger
2   Universitätsklinik für Innere Medizin I, Innsbruck, Austria
,
M Niederreiter
2   Universitätsklinik für Innere Medizin I, Innsbruck, Austria
,
RH Portugaller
3   Klinische Abteilung für Neuroradiologie, vaskuläre und interventionelle Radiologie, Graz, Austria
,
P Fickert
1   Klinische Abteilung für Gastroenterologie und Hepatologie, Graz, Austria
,
V Stadlbauer
› Author Affiliations
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Background and Aims The model for end-stage liver disease (MELD) is the best validated mortality predicting tool for patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). However, with creatinine being one of three parameters, MELD may have limited validity in patients with renal insufficiency, inter alia, because renal function improves after TIPS. We aimed to develop a modified TIPS score (MOTS), based on MELD, but easier to calculate and of higher accuracy in patients with renal insufficiency.

Methods We retrospectively analyzed 113 cases of TIPS-placement at the University Hospital Graz. A score integrating urea, INR and bilirubin was developed. MOTS ranged from 0-3 points: INR  > 1.6, urea  > 70 mg/dl and bilirubin  > 2.2 mg/dl imply plus one point each. Prognostic capability was assessed using Area Under Receiver Operating Characteristic (AUROC) statistics. The scores were validated in an external cohort from the University Hospital Innsbruck (n = 188).

Results In the training cohort as well as the validation cohort, both models significantly predicted 90-day mortality. AUROC values were similar: MELD 0.84 (95 % CI:0.74-0.96); MOTS 0.85 (0.74-0.96) in the training cohort and MELD 0.77 (0.62-0.93); MOTS 0.80 (0.67-0.94) in the validation cohort. 37 patients in our training cohort and 61 in the validation cohort had renal insufficiency defined as Estimated Glomerular Filtration Rate (eGFR)  < 60. In the training cohort, both scores predicted 90-day mortality in patients with eGFR  < 60, whereas MOTS had a higher AUROC value (MELD 0.77 (0.57-0.97); MOTS 0.85 (0.68-1.00)). In the validation cohort, only MOTS significantly predicted 90-day mortality in patients with eGFR  < 60 (MELD 0.76 (0.46-1.00), not significant; MOTS 0.81 (0.64-0.98), significant).

Conclusion With the simple MOTS, we developed a valuable tool to predict post-TIPS mortality, with higher accuracy than MELD in patients with renal impairment. To optimize future patient selection, prospective validation of MOTS is crucial.



Publication History

Article published online:
26 May 2020

© Georg Thieme Verlag KG
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