Various prognostic scores for patients with chronic liver disease have been applied for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) placement. In 2021, the Freiburg index of post-TIPS survival (FIPS) score was developed specifically for predicting survival after TIPS placement. The score has exhibited variable performance in initial investigations conducted in German and U.S. cohorts.
Objective: To compare utility of FIPS score and traditional scoring systems for predicting post-TIPS survival in a cohort of Chinese patients with cirrhosis.
Methods: This retrospective validation study compared four prognostic scores [Model for End-Stage Liver Disease (MELD), sodium MELD (MELD-Na), CLIF Consortium Acute Decompensation (CLIF-C AD), and FIPS] in 383 patients (mean age, 54.9±11.7 years; 249 men, 134 women) with cirrhosis who underwent TIPS placement (341 for variceal bleeding, 42 for refractory ascites) at Wuhan Union Hospital between January 2016 and August 2021. Model performance was assessed in terms of discrimination (using concordance index) and calibration (using Brier score and observed-to-predicted ratios) for 6-, 12- and 24-month post-TIPS survival. Discrimination was further stratified by TIPS indication. Risk stratification was performed using previously proposed cutoffs for each score.
Results: During postprocedural follow-up, 72 (18.8%) patients died. Discriminative performance for 6-month survival was highest for FIPS score (concordance index 0.784), followed by CLIF-C AD (0.743), MELD-Na (0.699), and MELD (0.694). FIPS score also showed highest calibration in terms of higher Brier scores and observed-to-predicted ratios closer to 1, as well as strongest prognostic performance for 12-month and 24-month survival and in subgroups of patients who underwent TIPS placement for either variceal bleeding or refractory ascites (except for similar performance of FIPS and CLIF-C AD in refractory ascites subgroup). When applying prior cutoffs, among patients classified as low risk by the other scores, further application of FIPS score was significantly associated with survival.
Conclusion: FIPS score outperformed traditional risk scores in predicting post-TIPS survival in patients with cirrhosis.
Clinical Impact: The findings support utility of FIPS score in differentiating patients who are optimal candidates for TIPS placement versus those at high risk who may instead warrant close monitoring and early liver transplantation