FIB-4 and APRI-scores predict survival in patients with transjugular intrahepatic portosystemic stent shunts

Background and aims Transjugular intrahepatic portosystemic shunt (TIPS) is a standard therapy in patients with liver cirrhosis. Interventional techniques and type of shunts have changed during the last 15 years. It is crucial to define easy and reliable factors associated with TIPS outcome, which however, may have different values depending on the shunt type and patient cohort. We here studied a homogenous single center cohort of TIPS patients and investigated predictors of patient survival.

Method We analyzed a total of 100 consecutive patients with liver cirrhosis evaluated for TIPS, which has been placed in 87 patients by two radiologists between January 2017 and November 2019. TIPS diameter was < 8 mm in 19 patients, 8 mm in 26 patients, and >8 mm in 42 patients. Major indication for TIPS was a hydropic decompensation (82/100 patients). Patients were followed for a median of 216 days (range 2-1012).

Results The majority of patients was male (57/87). Median age was 57 years (range 20-88), median BMI was 25,4kg/m2. Child Pugh A/B/C class were 25/55/7 patients. Patient survival after 3, 6 and 12 months was 82%, 75% and 70% respectively. Acute hepatic decompensation, defined as bilirubin increase >5g/dl as well as INR decrease, occurred within 3 months after TIPS in 9 cases. In univariate analysis, neither bilirubin nor INR or liver enzymes alone were associated with 6 and 12 months post-TIPS survival. However, both FIB-4 and APRI scores were associated with overall survival. The hazard ratio for death at 1 year was 3.5 (95% Confidence intervals 1-11) for patients with a FIB-4 score of >3.25 compared to < 1.45, and 4.7 (95% Confidence intervals 1-16) for an APRI score of >1.8 compared to patients with an APRI of < 1.

Conclusion A combination of markers reflecting portal hypertension and biochemical disease activity predicts long-term outcome after TIPS with most recent shunts using covered stents.

Abb 1 12 months survival according to APRI and FIB4-scores

Publication History

Article published online:
08 September 2020