Intermediate and long-term survival prediction using prognostic scores in patients undergoing salvage TIPS for uncontrolled variceal bleeding.

IF 0.6 4区医学 Q4 SURGERY South African Journal of Surgery Pub Date : 2024-05-01

J E J Krige, E G Jonas, M Setshedi, S J Beningfield, U K Kotze, M M Bernon, S Burmeister, J C Kloppers

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引用次数: 0

Abstract

Background: This study investigated the value of prognostic scores to predict 90-day, 1-, 3- and 5-year survival after salvage TIPS (sTIPS) in patients with exsanguinating variceal bleeding who failed endoscopic intervention.

Methods: The Model for End-Stage Liver Disease (MELD), Model for End-Stage Liver Disease Sodium (MELDNa), Acute Physiology and Chronic Health Evaluation II (APACHE II) and Child-Pugh (C-P) grades and scores were calculated using Kaplan-Meier curves and Cox proportional hazards models in sTIPS patients treated between August 1991 and November 2020.

Results: Thirty-four patients (29 men, 5 women), mean age 52 years, SD ± 11.6 underwent sTIPS which controlled bleeding in 32 (94%) patients. Ten (29.4%) patients died in hospital at a median of 4.8 (range 1-10) days. On bivariate analysis, C-P score ≥ 10 (p = 0.017), high C-P grade (p = 0.048), MELD ≥ 15 (p = 0.010), MELD-Na score ≥ 22 (p < 0.001) and APACHE II score ≥ 15 (p < 0.001) predicted 90-day mortality. Individual clinical characteristics associated with 90-day mortality were grade 3 ascites (p = 0.029), > 10 units of blood transfused (p = 0.004), balloon tube placement (p < 0.001), endotracheal intubation (< 0.001) and inotrope support (p < 0.001). The overall 90-day, 1-, 3- and 5-year survival rates were 67.6%, 55.9%, 26.5% and 20.6% respectively. Nine patients (26.5%) were alive at a median of two years (range 1-18 years) post-TIPS. Patients with C-P grade A, C-P score < 10, MELD score < 15, MELD-Na score < 22 and APACHE II score < 15 had significantly better 90-day, 1-, 3- and 5-year survival rates.

Conclusion: Although sTIPS controlled variceal bleeding in 94% of patients after failed endoscopic therapy, in-hospital mortality was 29% and less than one quarter were alive after five years. The selected cut-off values for the nominated scoring systems accurately predicted 90-day mortality and long-term survival.

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使用预后评分预测因静脉曲张出血未控制而接受抢救性 TIPS 患者的中期和长期生存率。

背景：本研究调查了预后评分在预测内镜干预失败的外溢性静脉曲张出血患者抢救性TIPS（sTIPS）后90天、1年、3年和5年生存率方面的价值：采用卡普兰-米尔曲线和考克斯比例危险模型计算了1991年8月至2020年11月期间接受治疗的sTIPS患者的终末期肝病模型（MELD）、终末期肝病钠模型（MELDNa）、急性生理学和慢性健康评价II（APACHE II）和Child-Pugh（C-P）分级和评分：34 名患者（29 名男性，5 名女性）接受了 sTIPS 治疗，平均年龄 52 岁，SD ± 11.6，其中 32 名患者（94%）的出血得到控制。10名患者（29.4%）在住院期间死亡，中位死亡时间为4.8天（范围1-10天）。双变量分析显示，C-P 评分≥ 10（p = 0.017）、C-P 等级高（p = 0.048）、MELD ≥ 15（p = 0.010）、MELD-Na 评分≥ 22（p < 0.001）和 APACHE II 评分≥ 15（p < 0.001）预示着 90 天死亡率。与 90 天死亡率相关的临床特征包括：3 级腹水（p = 0.029）、输血量大于 10 单位（p = 0.004）、球囊置管（p < 0.001）、气管插管（< 0.001）和肌力支持（p < 0.001）。90天、1年、3年和5年总生存率分别为67.6%、55.9%、26.5%和20.6%。9名患者（26.5%）在TIPS术后中位两年（1-18年）仍存活。C-P分级为A级、C-P评分<10分、MELD评分<15分、MELD-Na评分<22分和APACHE II评分<15分的患者的90天、1年、3年和5年生存率明显更高：尽管sTIPS能控制94%内镜治疗失败患者的静脉曲张出血，但院内死亡率为29%，5年后存活的患者不到四分之一。提名评分系统所选的临界值能准确预测 90 天死亡率和长期存活率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

South African Journal of Surgery 医学-外科

CiteScore

0.80

自引率

20.00%

发文量

审稿时长

>12 weeks

期刊介绍： The South African Journal of Surgery (SAJS) is a quarterly, general surgical journal. It carries research articles and letters, editorials, clinical practice and other surgical articles and personal opinion, South African health-related news, obituaries and general correspondence.