External validation of the Freiburg index of post-TIPS survival

Kraglund, Frederik; Gantzel, Rasmus Hvidbjerg; Jepsen, Peter; Aagaard, Niels Kristian

doi:10.1016/j.jhep.2021.04.027

Cited by 12 publications

(15 citation statements)

References 6 publications

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“…In the present study, however, while the FIPS score demonstrated a numerically higher discrimination versus MELD, MELD-Na, and CTP in the entire cohort, there was no appreciable improvement over MELD-Na in the modern TIPS era from 2014 to 2020. This was similarly seen in another small, single center study in which 104 patients receiving TIPS implantation between 2013 and 2018 demonstrated the FIPS score's poorer discriminatory performance when compared with MELD and CTP [21]. There are several potential explanations for this observation.…”

Section: Discussionmentioning

confidence: 60%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 60%

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

et al. 2021

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“…Due to the low number of high-risk patients the FIPS score did not show superior prognostic accuracy compared to the model for endstage liver disease (MELD) and Child-Pugh score. 1 Importantly, the authors mention that their cohort was similar to our FIPS cohort. 3 However, after reviewing the detailed description of the baseline characteristics of their study cohort, 4 it has to be mentioned that there are important differences compared to the FIPS cohort.…”

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confidence: 69%

“…To the Editor: With great interest, we have read the letters from Kraglund et al 1 and Wang et al 2 who provided external validation of the FIPS score 3 and also proposed a detailed risk stratification combining the Child-Pugh score and the FIPS score.…”

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confidence: 99%

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Reply to: Correspondence on “Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival”

Bettinger

Thimme

Schultheiß

2021

Journal of Hepatology

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“…22 However, in two external validation cohorts, the superiority of FIPS over MELD and Child-Pugh scores could not be confirmed. 23,24 The present study aimed to develop a modified TIPS score (MOTS), based on MELD, the current gold standard of post-TIPS mortality prediction, that can be calculated from routine laboratory parameters without any technical help and is widely applicable.…”

Section: Introductionmentioning

confidence: 99%

A novel score predicts mortality after transjugular intrahepatic portosystemic shunt: MOTS ‐ Modified TIPS Score

Fürschuß

Rainer

Effenberger

et al. 2022

Liver International

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Background and aims:The high risk for severe shunting-related post-interventional complications demands a stringent selection of candidates for transjugular intrahepatic portosystemic shunt (TIPS). We aimed to develop a simple and reliable tool to accurately predict early post-TIPS mortality.Methods: 144 cases of TIPS implantation were retrospectively analysed. Using univariate and multivariate Cox regression analysis of factors predicting mortality within 90 days after TIPS, a score integrating urea, international normalized ratio (INR) and bilirubin was developed. The Modified TIPS-Score (MOTS) ranges from 0 to 3 points: INR >1.6, urea >71 mg/dl and bilirubin >2.2 mg/dl account for one point each.Additionally, MOTS was tested in an external validation cohort (n = 187) and its performance was compared to existing models.Results: Modified TIPS-Score achieved a significant prognostic discrimination reflected by 90-day mortality of 8% in patients with MOTS 0-1 and 60% in patients with MOTS 2-3 (p < .001). Predictive performance (area under the curve) of MOTS was accurate (c = 0.845 [0.73-0.96], p < .001), also in patients with renal insufficiency (c = 0.830 [0.64-1.00], p = .02) and in patients with refractory ascites (c = 0.949 [0.88-1.00], p < .001), which are subgroups with particular room for improvement of post-TIPS mortality prediction. The results were reproducible in the validation cohort. Conclusions:Modified TIPS-Score is a novel, practicable tool to predict post-TIPS mortality, that can significantly simplify clinical decision making. Its practical applicability should be further investigated.

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External validation of the Freiburg index of post-TIPS survival

Cited by 12 publications

References 6 publications

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

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

Reply to: Correspondence on “Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival”

A novel score predicts mortality after transjugular intrahepatic portosystemic shunt: MOTS ‐ Modified TIPS Score

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