Freiburg index of post-TIPS survival (FIPS) a valid prognostic score in patients with cirrhosis but also an advisor against TIPS?

Abstract

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Reply to: “Freiburg index of post-TIPS survival (FIPS) a valid prognostic score in patients with cirrhosis but also an advisor against TIPS?”

“…However, although patient numbers were small after sufficient propensity score matching, the authors showed that in the FIPS low-risk group, patients with TIPS implantation had significantly better overall survival compared to patients treated with paracenteses. 2 Indeed, as suggested by the authors, this observation may further underline the rationale that TIPS implantation should not be delayed in patients with ascites. To further address this interesting aspect, we analyzed 296 patients who received TIPS implantation for refractory ascites at the University Medical Center Freiburg (baseline characteristics: Table S3) and in whom the time between first ascitic decompensation and TIPS implantation was recorded.…”

“…To the Editor: We thank Dr. Stockhoff and her team for their interest in our study 1 and their analyses that confirmed the prognostic impact of the Freiburg index of post-TIPS survival (FIPS) score and even expanded it to patients with decompensated cirrhosis without transjugular intrahepatic portosystemic shunt (TIPS) implantation. 2 With great interest, we recognize their efforts in addressing some important remaining questions from our study, especially with respect to the clinical application of the FIPS score for allocation to TIPS implantation. The authors point out several important issues which, however, require further attention.…”

“…First, they show that the FIPS score is also applicable to decompensated patients without TIPS implantation. 2 To address this hypothesis, we analyzed 612 patients with cirrhosis (baseline characteristics: Table S1) by stratifying according to decompensation stages defined by d'Amico et al 3 These stages are defined according to the kind and number of decompensating events (Table S2) and therefore reflect the severity of decompensation. Indeed, as shown in Fig.…”

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

“…Meanwhile, our results have been reproduced in 2 other independent cohorts of patients receiving TIPS. 2,6 Massoumy et al 6 and Wang et al 2 discussed if a modification of the cut-off for defining high-risk patients is necessary. Indeed, further validation of the FIPS score is necessary and these analyses should also focus on the determination of an optimal cut-off for selection of high-risk patients.…”

Reply to: “TIPS and liver transplantation should always be discussed together”

“…In summary, as shown by several independent groups, the FIPS score is a reliable tool for identifying high risk patients with decompensated cirrhosis. [3][4][5] Further, it will be important to analyze if the FIPS score could be useful in decision-making, not only in the TIPS setting, but also in patients allocated for LT.…”