The Freiburg Index of Post-TIPS Survival (FIPS) identifies patients at risk for further decompensation and ACLF after TIPS

IF 26.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepatology Pub Date : 2025-02-04 DOI:10.1016/j.jhep.2025.01.030

Lukas Sturm, Michael Schultheiss, Fabian Stöhr, Christian Labenz, Benjamin Maasoumy, Anja Tiede, Michael Praktiknjo, Leon Louis Seifert, Timo Alexander Auer, Uli Fehrenbach, Felix Piecha, Aenne Harberts, Johannes Kluwe, Tony Bruns, Maike Rebecca Pollmanns, Johannes Chang, Jakub Grobelski, Christian Jansen, Carsten Meyer, Marlene Reincke, Dominik Bettinger

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引用次数: 0

Abstract

Background & Aims

The Freiburg Index of Post-TIPS Survival (FIPS) defines a high-risk group of patients with significantly reduced survival following transjugular intrahepatic portosystemic shunt (TIPS) implantation. However, the clinical hallmarks responsible for these patients’ unfavorable outcome remain to be identified. Therefore, the present study aimed to characterize the clinical course after TIPS implantation according to the FIPS.

Methods

A total of 1359 patients with cirrhosis allocated to TIPS implantation for treatment of recurrent or refractory ascites or secondary prophylaxis of variceal bleeding from eight tertiary centers were retrospectively included. The patients’ clinical course following TIPS placement was analyzed, stratified according to the FIPS. Primary study outcome was further decompensation of cirrhosis within 90 days after TIPS, secondary outcomes were acute-on-chronic liver failure (ACLF) within 90 days and one-year transplant-free survival.

Results

Further decompensation after TIPS implantation was significantly more frequent in FIPS high-risk patients compared to low-risk patients (cumulative incidence function 0.58 vs. 0.38, p < 0.001). Moreover, FIPS high-risk patients developed ACLF significantly more often (0.18 vs. 0.08; p = 0.008). Uni- and multivariable competing risk regression analyses confirmed that the FIPS high-risk group independently predicted further decompensation (sHR 1.974, 95 % CI 1.531 – 2.544, p < 0.001) and ACLF after TIPS (sHR 2.586, 95 % CI 1.449 – 4.616, p = 0.001). Importantly, further decompensation and ACLF after TIPS were associated with significantly reduced transplant-free survival.

Conclusions

The present study reveals that the FIPS predicts development of further decompensation and ACLF after TIPS implantation. These events are responsible for impaired transplant-free survival in FIPS high-risk patients. These results pave the way for the development of tailored clinical management strategies.

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来源期刊

Journal of Hepatology 医学-胃肠肝病学

CiteScore

46.10

自引率

4.30%

发文量

2325

审稿时长

30 days

期刊介绍： The Journal of Hepatology is the official publication of the European Association for the Study of the Liver (EASL). It is dedicated to presenting clinical and basic research in the field of hepatology through original papers, reviews, case reports, and letters to the Editor. The Journal is published in English and may consider supplements that pass an editorial review.