Refining prediction of survival after TIPS with the novel Freiburg index of post-TIPS survival

Abstract Background and aim TIPS implantation is an effective and safe treatment for complications of portal hypertension. Prediction of survival is important in these patients as they constitute a high-risk population per se. Therefore, the aim of our study was to develop an alternative prognostic model for accurate survival prediction after planned TIPS implantation. Methods A total of 1871 patients with de novo TIPS implantation for ascites or secondary prophylaxis of variceal bleeding were recruited retrospectively. The study cohort was divided in a training set (80% of study patients; n=1496) and a validation set (20% of study patients; n=375). Further, patients with early (preemptive) TIPS implantation due to variceal bleeding were included as another validation cohort (n=290). Medical data and overall survival (OS) were assessed. A Cox regression model was performed to create an alternative prediction model, which includes significant prognostic factors. Results Age, bilirubin, albumin and creatinine were the most important prognostic factors. These parameters were included in a new score named the Freiburg index of post-TIPS survival (FIPS). The FIPS score was able to identify high-risk patients with a significantly reduced prognosis of a median survival of 5.0 [3.1 - 6.9] months after TIPS implantation in the training set. These results were confirmed in the validation set (median survival of 3.1 [0.9 - 5.3] months). The FIPS score showed better prognostic discrimination compared to the Child-Pugh-, MELD-, MELD-Na-score and the bilirubin-platelet model. However, the FIPS score showed insufficient prognostic discrimination in patients with early TIPS implantation. Conclusions The FIPS score is superior to established scoring systems for identifying high-risk patients with a reduced prognosis in patients with elective TIPS implantation.