Development and validation a prognostic score for TIPS placement in patients with viral hepatitis cirrhosis-related portal hypertension: a multi-center retrospective study

Abstract

Abstract Objectives Noninvasive methods are effective and promising way to predict the prognosis after transjugular intrahepatic portosystemic shunt (TIPS). However, there is no established scoring model focus on viral hepatitis including hepatitis B virus (HBV) and hepatitis C virus (HCV) patients to predict the survival of post-TIPS. In this study, we aimed to firstly develop (8 centers in southwestern China) and external validate (1 center in northeastern China) a novel model based on the largest cohort for better prediction of both short-term (1 year) and long-term (3 years) postoperative prognosis after TIPS in viral hepatitis cirrhosis-related portal hypertension patients. Methods A total of 925 viral hepatitis cirrhosis-related portal hypertension patients undergoing TIPS from nine hospitals were divided into the training (8 centers in southwestern China) and external validation (1 center in northeastern China) cohorts. A novel Viral-associated Index of Post-TIPS score (VIPs) model was built after performing cox regression. To verify the performance of novel model, we compared it with five previous models including Child‒Pugh, MELD, ALBI, CCG and FIPS scores. Furthermore, Using X-tile software to stratify patients into low-medium-high risk groups. Results We developed a novel VIP score model including age, ascites, albumin, prothrombin time, total bilirubin, and sodium for post-TIPS prognosis prediction. The novel model demonstrated a satisfying predictive efficiency in both discrimination and calibration, with an area under the curve of 0.781/0.774 (1-year/3-year) in the training cohort and 0.771/0.775 (1-year/3-year) in the external validation cohort, respectively. Using X-tile software, two optimal cutoff values (83 and 115) were generated to divide the entire cohort into three risk groups with significant difference in post-TIPS prognosis: low risk (score < 83), medium risk (score 83–115), and high risk (score > 115). Conclusions We firstly developed and external validated a novel VIPs model for better prediction of both short-term (1 year) and long-term (3 years) postoperative prognosis after TIPS in Chinese patients with viral hepatitis cirrhosis-related portal hypertension.