Brensing et al developed the BOTEM score to evaluate early mortality following placement of a transjugual intrahepatic portosystemic stent shunt (TIPSS). This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Bonn.
BOTEM is an acronym for Bonn TIPPS Early Mortality.
Patient selection: cirrhosis requiring TIPPS placement
Outcome: 60-day mortality
Parameters:
(1) serum total bilirubin in mg/dL
(2) APACHE II points
(3) urgency of TIPSS and indication
Parameter
Finding
Points
serum total bilirubin
< 3 mg/dL
1
3 to 6 mg/dL
2
> 6 mg/dL
3
APACHE II score
< 10
1
10 to 20
2
> 20
3
urgency of TIPSS
variceal bleeding AND elective
1
variceal bleeding AND urgent
2
variveal bleeding AND emergency
3
severe ascites AND no hepatorenal syndrome
1
severe asicted AND hepatorenal syndrome
2
where:
• Emergency variceal bleeding: active variceal bleeding AND balloon tamponade.
• Urgent variceal bleeding: salvage therapy <= 36 hours after last life-threatening variceal bleed.
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 9
• The higher the score the greater the risk for 60-day mortality.
Total Score
Risk
3 or 4
low (Grade I)
5 or 6
medium (Grade II)
7 to 9
high (Grade III)
Performance:
• Using a cutoff > 6 points, the sensitivity was 56% and specificity 100%.
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