External Validation of the FIPS Score for Post-TIPS Mortality in a National Veterans Affairs Cohort

Abstract

Background The Freiburg index of post-TIPS survival (FIPS) score was recently demonstrated to improve prediction of post-TIPS mortality relative to existing standards. As this score was derived from a German cohort over an extended time period, it is unclear if performance will translate well to other settings. This study aimed to externally validate the FIPS score in a large Veterans Affairs (VA) cohort over two separate eras of TIPS-related care. Methods This was a retrospective cohort study of patients with cirrhosis who underwent TIPS placement in the VA from 2008 to 2020. Cox regression models for post-TIPS survival were constructed using FIPS, MELD, MELD-Na, or CTP scores as predictors. Discrimination (Harrell's C) and calibration (joint tests of calibration curve slope and intercept) were evaluated for each score. A stratified analysis was performed for time periods between 2008-2013 and 2014-2020. ResultsThe cohort of 1,274 patients was 97.3% male with mean age 60.9 years and mean MELD-Na 14. The FIPS score demonstrated the highest overall discrimination versus MELD, MELD-Na, and CTP (0.634 vs. 0.585, 0.626, 0.612, respectively). However, in the modern treatment era (2014-2020), the FIPS score performed similarly to MELD-Na. Additionally, the FIPS score demonstrated poor calibration at one-month and six-month post-TIPS timepoints (joint p = 0.04 and 0.004, respectively). MELD, MELD-Na, and CTP were well-calibrated at each timepoint (each joint p > 0.05). ConclusionThe FIPS score performed similarly to MELD-Na in the modern TIPS treatment era and demonstrated regions of poor calibration. Future models derived with contemporary data may improve prediction of post-TIPS mortality.

Validating the prognostic value of Freiburg index of posttransjugular intrahepatic portosystemic shunt survival score and classic scores in Chinese patients with implantation of transjugular intrahepatic portosystemic shunt

“…[21] found that FIPS scores demonstrated the highest overall discrimination versus MELD, MELD-Na, and Child-Pugh. However, its performance in the modern TIPS treatment era is similar to that of MELD-Na [21]. Kraglund et al .…”

“…There have been some articles published so far on external validation of FIPS scores, but the conclusions have been inconsistent. Chapin et al [21] found that FIPS scores demonstrated the highest overall discrimination versus MELD, MELD-Na, and Child-Pugh. However, its performance in the modern TIPS treatment era is similar to that of MELD-Na [21].…”

A comprehensive review of prognostic scoring systems to predict survival after transjugular intrahepatic portosystemic shunt placement

“…Kraglund et al 77 reported that the discriminative ability (c‐index) of the FIPS score was only 0.59 at 3 months and 0.57 at 6 months after TIPS placement, significantly lower than those of the CTP (0.75, 0.72) and MELD (0.63, 0.60) scores at 3 and 6 months, respectively. Another study based on a large Veterans Affairs cohort in the United States also reported that the FIPS score showed a similar discriminative ability to the MELD‐Na score, with poor calibration 74 . When validating this score in Asian populations, Wang et al 72 analyzed data from 536 Chinese patients with cirrhosis undergoing TIPS and found that the CTP score exhibited higher discriminative ability than the FIPS score at each main time point (3, 6, 12, 24, and 36 months) after TIPS placement.…”

“…Another study based on a large Veterans Affairs cohort in the United States also reported that the FIPS score showed a similar discriminative ability to the MELD-Na score, with poor calibration. 74 When validating this score in Asian populations, Wang et al 72 analyzed data from 536 Chinese patients with cirrhosis undergoing TIPS and found that the CTP score exhibited higher discriminative ability than the FIPS score at each main time point (3,6,12,24, and 36 months) after TIPS placement. Conversely, another study including Chinese patients undergoing TIPS suggested that the FIPS score demonstrated higher discriminative ability than other scores in predicting both short-and long-term mortality after TIPS placement.…”

Survival prediction using the Freiburg index of post-TIPS survival (FIPS) in critically ill patients with acute- on chronic liver failure: A retrospective observational study

“…different cohorts (7)(8)(9)(10)(11). The use of the FIPS outside the TIPS setting, especially in patients with more advanced liver disease and particularly ACLF remains unclear.…”