Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts

ARTICLE HIGHLIGHTS

Research background

The transjugular intrahepatic portosystemic shunt (TIPS) represents a therapeutic modality for addressing complications associated with portal hypertension. This technique involves the creation of shunt pathways within the hepatic parenchyma, connecting the hepatic vein and the portal vein. The TIPS represents a valuable interim tool for patients with cirrhosis who are experiencing decompensation, as well as for individuals awaiting liver transplantation. Its applications encompass the management of conditions such as esophageal variceal bleeding and refractory ascites related to portal hypertension. However, there have been no specific studies on predicting long-term survival after TIPS placement.

Research motivation

The pressing need for a more accurate model for assessing long-term survival rates to guide treatment decisions in patients with chronic liver disease is emphasized. Therefore, we are committed to developing a model to predict the long-term survival of patients with hepatitis cirrhosis after TIPS.

Research objectives

The aim of our study was to establish a model to predict long-term survival in patients with hepatitis cirrhosis after the TIPS procedure.

Research methods

We conducted a retrospective study of 224 patients with PHT who received elective therapy and randomized them into training and validation sets. Continuous variables are presented as the mean with standard deviation, and categorical variables are presented as absolute and relative frequencies [n (%)]. Student’s t test or the Mann-Whitney U test was used to assess the differences in quantitative variables between the groups. The chi-square test was used for analyzing unordered categorical variables, while the Mann-Whitney U test was applied for examining ordered categorical variables. The Kaplan-Meier method was used to analyze differences in mortality risk among patients at different scoring levels, which were tested using the log-rank test. Cox regression was used to analyze the effect of each scoring model on the long-term prognosis of patients treated with the TIPS procedure. Receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the discrimination and calibration ability of the models. A nonparametric approach (Delong-Delong & Clarke-Pearson) was used for pairwise comparisons of the area under the ROC curves.

Research results

We devised a newly developed Cox (NDC) model for predicting long-term survival after TIPS in patients with hepatitis cirrhosis, which outperformed existing scoring models, such as the Child-Pugh, model for end-stage liver disease (MELD), MELD-sodium (MELD-Na) and the Freiburg index of post-TIPS survival (FIPS) scores, for predicting long-term survival.

Research conclusions

The NDC model can accurately predict long-term survival after the TIPS procedure in patients with hepatitis cirrhosis, help identify high-risk patients and guide follow-up management after TIPS implantation. Notably, the development of the NDC model offers a robust tool for predicting long-term survival post-TIPS, surpassing traditional models such as the Child-Pugh, MELD, MELD-Na and FIPS in terms of accuracy and reliability.

Research perspectives

We can learn from this study that the NDC model can predict long-term survival after TIPS, and its performance was better than that of other scores, such as Child-Pugh, MELD, MELD-Na and FIPS. Future studies should focus on developing more comprehensive prediction models with large-sample, multicenter datasets to improve the assessment of long-term survival in patients who underwent TIPS placement.