Chalasani et al reported a model for predicting mortality in a patient with cirrhosis following placement of a transjugular intrahepatic portosystemic shunt (TIPS). This can help to identify a patient who may require more aggressive management. The authors are from Indiana University in Indianapolis and Emory University in Atlanta.
Patient selection: advanced cirrhosis with TIPS
Parameters:
(1) variceal bleeding requiring emergent TIPS
(2) serum ALT in U/L
(3) serum total bilirubin in mg/dL
(4) hepatic encephalopathy prior to TIPS
Parameter
Finding
Points
variceal bleeding with emergency TIPS
no
0
yes
2
serum ALT
<= 100 U/L
0
> 100 U/L
1
serum total bilirubin
<= 3.0 mg/dL
0
> 3.0 mg/dL
1
hepatic encephalopathy
no
0
yes
1
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
Total Score
Risk Group
6 Month Survival
24 Month Survival
0
low
88%
67%
1 to 3
medium
62%
27%
4 or 5
high
8%
0%
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