A model for predicting poor survival in patients with cirrhosis undergoing portosystemic shunt embolization

Abstract

AbstractBackground and AimPortosystemic shunt embolization (PSSE) is a promising treatment for hepatic encephalopathy (HEP) and gastric varix (GV) in cirrhotic patients with a spontaneous portosystemic shunt. However, PSSE may worsen portal hypertension causing hepatorenal syndrome, liver failure, and mortality. This study aimed to develop and validate a prognostic model that helps identify patients with a risk of poor short‐term survival after PSSE.MethodsWe included 188 patients who underwent PSSE for recurrent HEP or GV at a tertiary center in Korea. To develop a prediction model for 6‐month survival after PSSE, Cox proportional‐hazard model was used. The developed model was validated in a separate cohort of 184 patients from two other tertiary centers.ResultsIn multivariable analysis, the 1‐year overall survival after PSSE was significantly associated with baseline levels of serum albumin, total bilirubin, and international normalized ratio (INR). We therefore developed the albumin‐bilirubin‐INR (ABI) score by assigning 1 point each for albumin < 3.0 g/dL, total bilirubin ≥ 1.5 mg/dL, and INR ≥ 1.5. Time‐dependent areas under the curve of the ABI score for predicting 3‐month and 6‐month survival were 0.85 and 0.85 in the development cohort and 0.83 and 0.78 in the validation cohort, indicating good discrimination performance. The ABI score showed a better discrimination and calibration performance than the model for end‐stage liver disease and the Child–Pugh scores, especially in high‐risk patients.ConclusionsThe ABI score is a simple prognostic model that helps decide whether to proceed with PSSE for the prevention of HEP or GV bleeding in patients with spontaneous portosystemic shunt.