The Freiburg Index of Post-TIPS Survival (FIPS) identifies patients with further decompensation after transjugular intrahepatic portosystemic shunt implantation: a multicenter observational study

Introduction The Freiburg Index of Post-TIPS Survival (FIPS) defines a high-risk group of patients with significantly impaired survival following TIPS implantation. As further decompensation is significantly associated with reduced survival, we hypothesized that further decompensation may be an important hallmark in FIPS high-risk patients after TIPS.

Methods 1514 cirrhosis patients allocated to TIPS implantation for treatment of refractory ascites or secondary prophylaxis of variceal bleeding from eight centers were retrospectively included. Primary outcome was further decompensation within 90 days after TIPS. Secondary outcomes were the development of acute-on-chronic liver failure (ACLF) within 90 days and one-year transplant-free survival.

Results The cumulative incidence of further decompensation, with death and liver transplantation as competing risks, was significantly higher in FIPS high-risk patients compared to low-risk patients (0.56 vs. 0.36). Moreover, the cumulative incidence of ACLF within 90 days after TIPS was markedly increased in high-risk patients (0.37 vs. 0.11). Uni- and multivariable competing risk-regression analyses confirmed that FIPS high-risk classification was an independent predictor of further decompensation (SHR 1.768, 95% CI 1.454 – 2.149, p<0.001) and ACLF after TIPS (SHR 1.943, 95% CI 1.276 – 2.958, p=0.002). Further decompensation and the development of ACLF after TIPS were associated with significantly reduced transplant-free survival.

Conclusions The present study reveals that the FIPS predicts further decompensation after TIPS implantation, which might explain impaired survival in FIPS high-risk patients. Therefore, tailored clinical management strategies including early evaluation for liver transplantation for FIPS high-risk patients should be considered.

Publikationsverlauf

Artikel online veröffentlicht:
23. Januar 2024