Liver and Bile

Hepatology. 2024;79(1):118–34

Lv Y, Bai W, Zhu X, Xue H, Zhao J, Zhuge Y, Sun J, Zhang C, Ding P, Jiang Z, Zhu X, Ren W, Li Y, Zhang K, Zhang W, Li K, Wang Z, Luo B, Li X, Yang Z, Guo W, Xia D, Xie H, Pan Y, Yin Z, Fan D, Han G

Development and validation of a prognostic score to identify the optimal candidate for pre-emptive TIPS in patients with cirrhosis and acute variceal bleeding

Background and aim: Baveno VII workshop recommends the use of pre-emptive transjugular intrahepatic portosystemic shunt (p-TIPS) in patients with cirrhosis and acute variceal bleeding (AVB) at high risk of treatment failure. However, the criteria defining “high risk” have low clinical accessibility or include subjective variables. The authors aimed to develop and externally validate a model for better identification of p-TIPS candidates.
Approach and results: The derivation cohort included 1554 patients with cirrhosis and AVB who were treated with endoscopy plus drug (n = 1264) or p-TIPS (n = 290) from 12 hospitals in China between 2010 and 2017. The authors first used competing risk regression to develop a score for predicting 6-week and 1-year mortality in patients treated with endoscopy plus drugs, which included age, albumin, bilirubin, international normalized ratio, white blood cell, creatinine, and sodium. The score was internally validated with the bootstrap method, which showed good discrimination (6-week/1-year concordance-index: 0.766/0.740) and calibration, and outperformed other currently available models. In the second stage, the developed score was combined with treatment and their interaction term to predicate the treatment effect of p-TIPS (mortality risk difference between treatment groups) in the whole derivation cohort. The estimated treatment effect of p-TIPS varied substantially among patients. The prediction model had good discriminative ability (6-week/1-year c-for-benefit: 0.696/0.665) and was well calibrated. These results were confirmed in the validation dataset of 445 patients with cirrhosis with AVB from 6 hospitals in China between 2017 and 2019 (6-week/1-year c-for-benefit: 0.675/0.672).

Conclusions: The authors developed and validated a clinical prediction model that can help to identify individuals who will benefit from pre-emptive transjugular intrahepatic portosystemic shunt, which may guide clinical decision-making.

Prof. Dr. G. Han, Department of Liver Diseases and Digestive Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwest University, Xi’an, China, E-Mail: hangh@fmmu.edu.cn

DOI: 10.1097/hep.0000000000000548

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Liver and Bile

Adequate versus deep response to ursodeoxycholic acid in primary biliary cholangitis: To what extent and under what conditions is normal alkaline phosphatase level associated with complication-free survival gain?

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Liver and Bile

Lack of complete biochemical response in autoimmune hepatitis leads to adverse outcome: First report of the IAIHG retrospective registry

Hepatology. 2024;79(3):538–50