Lv YF, Zhu B, Meng MM, Wu YF, Dong CB, Zhang Y, Liu BW, You SL, Lv S, Yang YP, Liu FQ. Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts. World J Gastrointest Surg 2024; 16(2): 491-502 [PMID: 38463355 DOI: 10.4240/wjgs.v16.i2.491]
Corresponding Author of This Article
Fu-Quan Liu, BCPS, Chief Doctor, Professor, Liver Disease Minimally Invasive Diagnosis and Treatment Center, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. lfuquan@aliyun.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Feb 27, 2024; 16(2): 491-502 Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.491
Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts
Yi-Fan Lv, Ming-Ming Meng, Yi-Fan Wu, Cheng-Bin Dong, Yu Zhang, Bo-Wen Liu, Fu-Quan Liu, Liver Disease Minimally Invasive Diagnosis and Treatment Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Bing Zhu, Shao-Li You, Sa Lv, Yong-Ping Yang, Liver Vascular Disease Diagnosis and Treatment Center, The Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100039, China
Co-first authors: Yi-Fan Lv and Bing Zhu.
Author contributions: Lv YF and Zhu B analyzed the data and wrote the paper; Meng MM, Wu YF, Dong CB, Zhang Y, Liu BW, You SL and Lv S performed the research; Liu FQ and Yang YP designed the research; Liu FQ and Yang YP reviewed and edited the manuscript; Lv YF and Zhu B contributed equally to this work as co-first authors; All the authors read and approved the manuscript.
Supported bythe Talent Training Plan during the "14th Five-Year Plan" period of Beijing Shijitan Hospital Affiliated to Capital Medical University, No. 2023LJRCLFQ.
Institutional review board statement: The study was reviewed and approved by the Beijing Shijitan Hospital Institutional Review Board and was performed in accordance with the Declaration of Helsinki.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, BCPS, Chief Doctor, Professor, Liver Disease Minimally Invasive Diagnosis and Treatment Center, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. lfuquan@aliyun.com
Received: November 21, 2023 Peer-review started: November 21, 2023 First decision: December 12, 2023 Revised: December 23, 2023 Accepted: January 12, 2024 Article in press: January 12, 2024 Published online: February 27, 2024 Processing time: 96 Days and 1.8 Hours
Abstract
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) placement is a procedure that can effectively treat complications of portal hypertension, such as variceal bleeding and refractory ascites. However, there have been no specific studies on predicting long-term survival after TIPS placement.
AIM
To establish a model to predict long-term survival in patients with hepatitis cirrhosis after TIPS.
METHODS
A retrospective analysis was conducted on a cohort of 224 patients who underwent TIPS implantation. Through univariate and multivariate Cox regression analyses, various factors were examined for their ability to predict survival at 6 years after TIPS. Consequently, a composite score was formulated, encompassing the indication, shunt reasonability, portal venous pressure gradient (PPG) after TIPS, percentage decrease in portal venous pressure (PVP), indocyanine green retention rate at 15 min (ICGR15) and total bilirubin (Tbil) level. Furthermore, the performance of the newly developed Cox (NDC) model was evaluated in an internal validation cohort and compared with that of a series of existing models.
RESULTS
The indication (variceal bleeding or ascites), shunt reasonability (reasonable or unreasonable), ICGR15, postoperative PPG, percentage of PVP decrease and Tbil were found to be independent factors affecting long-term survival after TIPS placement. The NDC model incorporated these parameters and successfully identified patients at high risk, exhibiting a notably elevated mortality rate following the TIPS procedure, as observed in both the training and validation cohorts. Additionally, in terms of predicting the long-term survival rate, the performance of the NDC model was significantly better than that of the other four models [Child-Pugh, model for end-stage liver disease (MELD), MELD-sodium and the Freiburg index of post-TIPS survival].
CONCLUSION
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.
Core Tip: The core finding of this article is that a newly developed Cox regression model (NDC) outperforms the existing scoring models, such as the Child-Pugh, model for end-stage liver disease (MELD), MELD-sodium and the Freiburg index of post-transjugular intrahepatic portosystemic shunt (TIPS) survival, in predicting long-term survival after TIPS placement in patients with hepatitis cirrhosis. In the NDC model, considered factors such as indication for TIPS, shunt reasonability, indocyanine green retention rate at 15 min, post-portal venous pressure gradient, percentage decrease in portal venous pressure, and total bilirubin are considered. It provided a more accurate prediction of 6-year survival, allowing for the identification of high-risk patients who may need closer follow-up after the procedure.
