Prognostic Value of the CLIF‐C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt

Abstract

Prognostic assessment of patients with liver cirrhosis allocated for implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a challenging task in clinical practice. The aim of our study was to assess the prognostic value of the CLIF‐C AD (Acute Decompensation) score in patients with TIPS implantation. Transplant‐free survival (TFS) and 3‐month mortality were reviewed in 880 patients who received de novo TIPS implantation for the treatment of cirrhotic portal hypertension. The prognostic value of the CLIF‐C AD score was compared with the Model for End‐Stage Liver Disease (MELD) score, Child‐Pugh score, and albumin‐bilirubin (ALBI) score using Harrell’s C concordance index. The median TFS after TIPS implantation was 40.0 (34.6‐45.4) months. The CLIF‐C AD score (c = 0.635 [0.609‐0.661]) was superior in the prediction of TFS in comparison to MELD score (c = 0.597 [0.570‐0.623], P = 0.006), Child‐Pugh score (c = 0.579 [0.552‐0.606], P < 0.001), and ALBI score (c = 0.573 [0.545‐0.600], P < 0.001). However, the CLIF‐C AD score did not perform significantly better than the MELD‐Na score (c = 0.626 [0.599‐0.653], P = 0.442). There were no profound differences in the scores’ ranking with respect to indication for TIPS implantation, stent type, or underlying liver disease. Subgroup analyses revealed that a CLIF‐C AD score >45 was a predictor of 3‐month mortality in the supposed low‐risk group of patients with a MELD score ≤12 (14.7% vs. 5.1%, P < 0.001). Conclusion: The CLIF‐C AD score is suitable for prognostic assessment of patients with cirrhotic portal hypertension receiving TIPS implantation. In the prediction of TFS, the CLIF‐C AD score is superior to MELD score, Child‐Pugh score, and ALBI score but not the MELD‐Na score.

A novel score predicts mortality after transjugular intrahepatic portosystemic shunt: MOTS ‐ Modified TIPS Score

“…found the CLIF-C AD score to be a suitable prognostic tool. 33 4) 84 ( 8) 79 ( 13) 76 ( 15) MOTS 1 7 0 (0) 65 ( 5) 62 ( 7) 58 ( 9) 52 ( 14) Several aspects support the assumption that creatinine may not be an ideal prognostic indicator for patients undergoing TIPS. First, the majority of TIPS candidates are patients with decompensated cirrhosis.…”

“…Furthermore, although previous studies have shown predictive inferiority to MELD, 10,14,32 Child‐Pugh score is still broadly used for the selection of patients to receive TIPS. In a recent study, Sturm et al found the CLIF‐C AD score to be a suitable prognostic tool 33 . One thousand and eighty‐eight cases of TIPS placement were analysed, patients who met the criteria of acute‐on‐chronic liver failure (19%) were excluded.…”

Validating the prognostic value of Freiburg index of posttransjugular intrahepatic portosystemic shunt survival score and classic scores in Chinese patients with implantation of transjugular intrahepatic portosystemic shunt

“…In subgroup analysis, none of the models showed significant differences in predictive effect in patients with viral cirrhosis and patients treated for variceal hemorrhage, consistent with the results of Sturm et al . [6]. In patients with nonviral cirrhosis, the Child-Pugh score was significantly better than the FIPS score in predicting 3-month mortality.…”

“…Studies have shown that the mortality in hospitals after TIPS is 2.3-16.3%, and the mortality at 3 months is 7.9-27.0% [2,3]. Currently, many models have been used to evaluate the outcome of patients treated with TIPS, such as the Child-Pugh score, the model for end-stage liver disease (MELD) score, MELD-Na score, and Chronic Liver Failure Consortium Acute Decompensation (CLIF-C AD) score [4][5][6].…”

Implantation of transjugular intrahepatic portosystemic shunt (TIPS): indication and patient selection

“…But, moreover, it has been shown that patientspecific factors such as sarcopenia and cardiac parameters are important risk factors for a negative outcome after TIPS implantation [46][47][48]. There have also been several clinical liver-specific scores such as the Child-Pugh, model for endstage liver disease (MELD [-sodium]) and the chronic liver failure acute decompensation score (CLIF C-AD score) that have been used to predict prognosis after TIPS implantation [49]. However, only the MELD score has been specifically developed for prediction of 3-months mortality after TIPS implantation and is currently predominantly used for allocation to liver transplantation.…”