Transjugular intrahepatic portosystemic shunt survival
Info
Serum creatinine (mg/dl)
unit µmol/L mg/dL
Serum concentrations of bilirubin (mg/dl)
unit µmol/L mg/dL
International normalized ratio for prothrombin time (INR)
Cause of Cirrhosis Alcohol-related liver disease Cholestatic liver disease All other causes
R e s u l t s
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Risk Score R
 
Survival post TIPS:
 
1 day:
 
7 days:
 
30 days:
 
90 days:
 
6 months:
 
1 years:
 
2 years:
 
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Transjugular intrahepatic portosystemic shunt survival

The Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is sometime recommended in patients with portal hypertension, especially in those with variceal bleeding or ascites.

Although TIPS plus medical therapy appears superior to medical therapy alone for ascites; in some studies, it does not appear to improve survival, hospitalization rates or quality of life. A meta-analysis indicates improved transplant-free survival in cirrhotic patients with refractory ascites; however, hepatic encephalopathy was also more common in the TIPS group.

The outcome, when the TIPS procedure is recommended requires consideration, as some patients may realize worsening hepatic function and decreased survival.

Malinchoc's 2000 article in Hepatology, based upon 231 patients who underwent elective TIPS (173 for prevention of variceal rebleeding and 58 for refractory ascites), identified items that predict survival in patients undergoing elective TIPS.

The first item is a risk score R, which when R >1.8 indicates a median survival of 3 months or less. The following items are required to calculate the risk score R.

  • serum bilirubin (S bi ) in mg/dL
  • serum creatinine (S cr ) in mg/dL
  • International normalized ratio for prothrombin time (INR)
  • The Cause of Cirrhosis (C)
    • C=0 for alcohol-related liver disease or cholestatic liver disease
    • C=1 for all other causes of liver disease
  • Days of survival (SD)

The formula for the Risk Score (R) is:

  • R = 0.957 * log e (S cr ) +0.378*log e (S bi ) +1.12*log e (INR) +0.643*C

Patients with R >1.8 had median survival of 3 months or less.
Patients with R <=1.8 had median survival greater than 3 months.

After Risk Score is calculated to obtain the Probability Of Survival (POS) for a certain number of days after TIPS, we use the equation:

  • POS = S (t) exp(R-1.127)
  • where 1.127 = Average patient Risk Score.
  • S (t) = Estimated survival probability for an average patient undergoing elective TIPS for days SD.

The table below shows the S (t) to be used for its respective number of survival days SD:

SD S(t)
1 0.99
7 0.966
30 0.86
90 0.707
183 0.621
365 0.551
730 0.428

* Note: The model is likely to lose its accuracy the longer a patient is followed because other factors such as development of shunt stenosis, or a hepatocellular carcinoma may negatively impact survival.

References:

  1. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864-81.
  2. Saab S, Nieto JM, Lewis SK, et al. TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD0048889.
  3. Salerno F, Cammà C, Enea M, et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007 Sep;133(3):825-34.
  4. Sanyal AJ, Cammà C, Enea M, et al. North American Study for the Treatment of Refractory Ascites Group. Gastroenterology. 2003 Mar;124(3):634-41.