Open AccessPrognostic Value of the CLIF‐C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt
Author(s) -
Sturm Lukas,
Praktiknjo Michael,
Bettinger Dominik,
Huber Jan P.,
Volkwein Lara,
Schmidt Arthur,
Kaeser Rafael,
Chang Johannes,
Jansen Christian,
Meyer Carsten,
Thomas Daniel,
Thimme Robert,
Trebicka Jonel,
Schultheiß Michael
Publication year - 2021
Publication title -
hepatology communications
Language(s) - English
Resource type - Journals
ISSN - 2471-254X
DOI - 10.1002/hep4.1654
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , model for end stage liver disease , cirrhosis , gastroenterology , liver disease , portal hypertension , decompensation , framingham risk score , log rank test , liver transplantation , survival analysis , disease , transplantation
Prognostic assessment of patients with liver cirrhosis allocated for implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a challenging task in clinical practice. The aim of our study was to assess the prognostic value of the CLIF‐C AD (Acute Decompensation) score in patients with TIPS implantation. Transplant‐free survival (TFS) and 3‐month mortality were reviewed in 880 patients who received de novo TIPS implantation for the treatment of cirrhotic portal hypertension. The prognostic value of the CLIF‐C AD score was compared with the Model for End‐Stage Liver Disease (MELD) score, Child‐Pugh score, and albumin‐bilirubin (ALBI) score using Harrell’s C concordance index. The median TFS after TIPS implantation was 40.0 (34.6‐45.4) months. The CLIF‐C AD score (c = 0.635 [0.609‐0.661]) was superior in the prediction of TFS in comparison to MELD score (c = 0.597 [0.570‐0.623], P = 0.006), Child‐Pugh score (c = 0.579 [0.552‐0.606], P < 0.001), and ALBI score (c = 0.573 [0.545‐0.600], P < 0.001). However, the CLIF‐C AD score did not perform significantly better than the MELD‐Na score (c = 0.626 [0.599‐0.653], P = 0.442). There were no profound differences in the scores’ ranking with respect to indication for TIPS implantation, stent type, or underlying liver disease. Subgroup analyses revealed that a CLIF‐C AD score >45 was a predictor of 3‐month mortality in the supposed low‐risk group of patients with a MELD score ≤12 (14.7% vs. 5.1%, P < 0.001). Conclusion: The CLIF‐C AD score is suitable for prognostic assessment of patients with cirrhotic portal hypertension receiving TIPS implantation. In the prediction of TFS, the CLIF‐C AD score is superior to MELD score, Child‐Pugh score, and ALBI score but not the MELD‐Na score.