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

Abstract

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.

• Authors: Lukas Sturm, Michael Praktiknjo, Dominik Bettinger, Jan P Huber, Lara Volkwein, Arthur Schmidt, Rafael Kaeser, Johannes Chang, Christian Jansen, Carsten Meyer, Daniel Thomas, Robert Thimme, Jonel Trebicka, Michael Schultheiß
• Journal: Hepatology communications (Hepatol Commun) Vol. 5 Issue 4 Pg. 650-660 (04 2021) ISSN: 2471-254X [Electronic] United States
• PMID: 33860123 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of the American Association for the Study of Liver Diseases.

Topics

• Adult
• Aged
• Humans
• Hypertension, Portal (etiology, mortality, surgery)
• Liver Cirrhosis (complications)
• Middle Aged
• Portasystemic Shunt, Transjugular Intrahepatic
• Prognosis
• Severity of Illness Index
• Survival Analysis