Predicting death or recurrence of portal hypertension symptoms after TIPS procedures

• Published in: European radiology 2022-05, Vol.32 (5), p.3346-3357
• Main Authors: Sun, Shawn H., Eche, Thomas, Dorczynski, Chloé, Otal, Philippe, Revel-Mouroz, Paul, Zadro, Charline, Partouche, Ephraim, Fares, Nadim, Maulat, Charlotte, Bureau, Christophe, Schwartz, Lawrence H., Rousseau, Hervé, Dercle, Laurent, Mokrane, Fatima-Zohra
• Format: Article
• Language: English
• Subjects: Age; Algorithms; Biomarkers; Clinical Decision-Making; Computed tomography; Decision making; Decision trees; Diagnostic Radiology; Epidemiology; Gastrointestinal; Humans; Hypertension; Hypertension, Portal - surgery; Imaging; Implants; Internal Medicine; Interventional Radiology; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Mathematical analysis; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Portasystemic Shunt, Transjugular Intrahepatic; Radiology; Retrospective Studies; Signs and symptoms; Stents; Survival; Training; Treatment Outcome; Ultrasound; Variables
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-08437-0

Background Accurate prediction of portal hypertension recurrence after transjugular intrahepatic portosystemic shunt (TIPS) placement will improve clinical decision-making. Purpose To evaluate if perioperative variables could predict disease-free survival (DFS) in cirrhotic patients with portal hypertension (PHT) treated with TIPS. Materials and methods We recruited 206 cirrhotic patients with PHT treated with TIPS, randomly assigned to training ( n  = 138) and validation ( n  = 68) sets. We recorded 7 epidemiological, 4 clinical, and 9 radiological variables. TIPS-distal end positioning (TIPS-DEP) measured the distance between the distal end of the stent and the hepatocaval junction on contrast-enhanced CT scans. In the training set, the signature was defined as the random forest for survival algorithm achieving the lowest error rate for the prediction of DFS which was landmarked 4 weeks after the TIPS procedure. In the training set, a simple to use scoring system was derived from variables selected by the signature. The primary endpoint was to assess if TIPS-DEP was associated with DFS. The secondary endpoint was to validate the scoring system in the validation set. Results Overall, patients with TIPS-DEP ≥ 6 mm ( n  = 49) had a median DFS of 24.5 months vs. 72.8 months otherwise ( n  = 157, p  = 0.004). In the training set, the scoring system was calculated by adding age ≥ 60 years old, Child–Pugh B or C, and TIPS-DEP ≥ 6 mm (1 point each) since the signature showed high DFS probability at 6.5 months post-landmark in patients that did not meet these criteria: 86%, 80%, and 78%, respectively. The hazard ratio [95 CI] between patients determined to be low-risk (