Albumin-bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation

Ronald, James; Wang, Q.; Choi, Steven S; Suhocki, Paul V.; Hall, Matthew J.; Smith, Tony P.; Kim, C.Y.

doi:10.1016/j.diii.2017.10.008

Cited by 36 publications

(28 citation statements)

References 30 publications

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“…(7,8) The ALBI score has been discussed as a possible alternative model, but so far has not proven suitable as predictor for survival after TIPS implantation. (25,26) Importantly, the MELD score has several limitations, too. Indeed, it was observed that the MELD score tends to overestimate mortality and, designed to predict short-term mortality, its prognostic value significantly decreases in the long term.…”

Section: Discussionmentioning

confidence: 99%

“…As prior studies evaluating prognostic scores in patients with TIPS implantation investigated smaller patient numbers, a quantum of 880 patients appears reasonably high to achieve dependable results. (5,8,25,26,33) Notably, the cohort in which the CLIF-C AD score was developed accounted for 1,016 patients (plus 225 patients for validation). (9) Still, including a larger number of patients and more than two centers in the analysis may contribute to obtaining even more valid results.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of the CLIF‐C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the CLIF‐C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt

et al. 2021

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“…The ALBI grade is more objective and predictable in those treated with RT, especially those with minimal liver dysfunction [ 39 ]. Moreover, ALBI is simple, objective, and clinically feasible in comparison to other parameters for evaluating the liver function [ 40 , 41 ]. Therefore, it is essential to find suitable candidates for iA-CCRT, considering the various parameters of the liver function.…”

Section: Discussionmentioning

confidence: 99%

Phase I Radiation Dose-Escalation Study to Investigate the Dose-Limiting Toxicity of Concurrent Intra-Arterial Chemotherapy for Unresectable Hepatocellular Carcinoma

Cho

Kim

et al. 2020

Cancers

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Concurrent intra-arterial chemotherapy and radiotherapy (iA-CCRT) can increase the response rate in hepatocellular carcinoma (HCC), but may cause a higher toxicity. We conducted this Phase I study to investigate the dose-limiting toxicity of iA-CCRT for HCC. In total, 52.5 Gy in 25 fractions was prescribed as planning target volume (PTV) 1 at dose level 1. The dose escalation was 0.2 Gy per fraction and up to 2.5 Gy, with 62.5 Gy at level 3. Concurrent intra-arterial 5-fluorouracil was administered during the first and fifth weeks of radiotherapy (RT). Toxicities were graded using the Common Toxicity Criteria for Adverse Events, version 4.0. Results: Seventeen patients with HCC were analyzed: four at dose level 1, 6 at level 2, and 7 at level 3. The mean irradiated dose administered to the uninvolved liver at each dose level was 21.3, 21.6, and 18.2 Gy, respectively. There was no grade ≥3 gastrointestinal toxicity; two patients experienced grade 3 hyperbilirubinemia. All patients had Child-Pugh class A disease, but 3 patients developed class B disease after iA-CCRT. During a median follow-up of 13 months, the median progression-free survival (PFS) and overall survival (OS) were 10 and 22 months, respectively. Patients treated at dose level 3 showed improved PFS and OS. Conclusions: Radiation dose escalation of iA-CCRT did not cause any significant toxicities in patients with advanced HCC. Further large-scale studies with long-term follow-up are needed to determine the efficacy and feasibility of higher doses of iA-CCRT.

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“…In the case in which portal hypertension may have intrahepatic origin, which is common in chronic hepatic insufficiency, a severe and progressive metabolic insufficiency is associated. This metabolic hepatic insufficiency is evaluated through the Child and the Model For End-Stage Liver Disease MELD scores [38,39]. The Child–Pugh (CP) classification is one of the most common bedside tools utilized in medicine for gauging the severity of liver disease and estimating prognosis in the patient with cirrhosis.…”

Section: The Mast Cell and The Lymphatic Gut-liver Axismentioning

confidence: 99%

“…CP is a composite ordinal score consisting of three laboratory-based biomarkers (serum albumin levels, serum bilirubin levels, and prothrombin time) and two clinically assessed variables (presence/degree of ascites and presence/degree of hepatic encephalopathy) [38]. The present version of MELD score incorporated only 4 objective variables, including total bilirubin, creatinine, international normalized ratio (INR) and serum sodium level [39]. Therefore, this noxious pathological liver-related factor would condition the evolution of the lymphatic impairment of portal hypertension.…”

Section: The Mast Cell and The Lymphatic Gut-liver Axismentioning

confidence: 99%

The Lymphatic Headmaster of the Mast Cell-Related Splanchnic Inflammation in Portal Hypertension

Aller

Blanco-Rivero

Arias

et al. 2019

Cells

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Portal hypertension is a common complication of liver disease, either acute or chronic. Consequently, in chronic liver disease, such as the hypertensive mesenteric venous pathology, the coexisting inflammatory response is classically characterized by the splanchnic blood circulation. However, a vascular lymphatic pathology is produced simultaneously with the splanchnic arterio-venous impairments. The pathological increase of the mesenteric venous pressure, by mechanotransduction of the venous endothelium hyperpressure, causes an inflammatory response involving the subendothelial mast cells and the lymphatic endothelium of the intestinal villi lacteal. In portal hypertension, the intestinal lymphatic inflammatory response through the development of mesenteric-systemic lymphatic collateral vessels favors the systemic diffusion of substances with a molecular pattern associated with damage and pathogens of intestinal origin. When the chronic hepatic insufficiency worsens the portal hypertensive inflammatory response, the splanchnic lymphatic system transports the hyperplasied intestinal mast cells to the mesenteric lymphatic complex. Then, an acquired immune response regulating a new hepato-intestinal metabolic scenario is activated. Therefore, reduction of the hepatic metabolism would reduce its key centralized functions, such as the metabolic, detoxifying and antioxidant functions which would try to be substituted by their peroxisome activity, among other functions of the mast cells.

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Albumin-bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation

Cited by 36 publications

References 30 publications

Prognostic Value of the CLIF‐C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt

Prognostic Value of the CLIF‐C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt

Phase I Radiation Dose-Escalation Study to Investigate the Dose-Limiting Toxicity of Concurrent Intra-Arterial Chemotherapy for Unresectable Hepatocellular Carcinoma

The Lymphatic Headmaster of the Mast Cell-Related Splanchnic Inflammation in Portal Hypertension

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