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
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.