Complications of portal hypertension are increasingly being treated using transjugular intrahepatic portosystemic stent-shunt (TIPSS). However, there are no proven tools for risk assessment of early mortality currently available.
Writing in the July issue of the European Journal of Gastroenterology and Hepatology, researchers report their findings on the prospective evaluation of a new 60-day mortality score.
The research, carried out by members of the Departments of Internal Medicine and Radiology at the University of Bonn, in Bonn, Germany, was initially conducted on 30 consecutive TIPSS patients (Group 1).
All subjects were analyzed for early mortality predictors, including Child-Pugh score, TIPSS urgency (elective: 36 hours or more, or emergency: less than 36 hours after variceal bleeding), comorbidity (Acute Physiology and Chronic Health Evaluation [APACHE]-II) and clinical data.
Within Group 1 (Child-Pugh score 10A, 10B, 10C) main predictors were graded as 1, 2, or 3 points, representing low, medium, and high risk, and summarized as a Bonn TIPSS early mortality (BOTEM) score.
This score was then tested prospectively in the next 73 TIPSS patients (Group 2: Child-Pugh score 14A, 42B, 17C).
| BOTEM score - could predict early mortality with up to 96% accuracy. |
| European Journal of Gastroenterology and Hepatology |
For Group 1 patients, bilirubin, APACHE-II, and TIPSS urgency were found to be primary indicators of early mortality (30%).
Added risk points (1, 2, 3) for bilirubin (less than 3 mg/dl, 3-6 mg/dl, greater than 6 mg/dl, respectively), APACHE-II (less than 10, 10-20, greater than 20 points, respectively) and urgency (elective, emergency, active bleeding, respectively) represented individual BOTEM score points.
In both groups BOTEM was the best mortality predictor, with a score of 6 points being the optimal cut-off. In Group 1 BOTEM score was able to provide 56% sensitivity, 100% specificity, 100% positive predictive value, 84% negative predictive value and 87% accuracy.
This compared to respective values in Group 2 of 67%, 99%, 80%, and 97%, with accuracy being slightly higher than in Group 1 at 96%.
The research group concludes that a BOTEM score based upon bilirubin, comorbidity, and TIPSS-urgency can reliably predict post-TIPSS 60-day mortality and that such a score might optimize TIPSS treatment.