A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts
Open accessAbstract
Transjugular intrahepatic portosystemic shunts (TIPS) may worsen liver function and decrease survival in some patients. The Child-Pugh classification has several drawbacks when used to determine survival in such patients. The survival of 231 patients at 4 medical centers within the United States who underwent elective TIPS was studied to develop statistical models to (1) predict patient survival and (2) identify those patients whose liver-related mortality post-TIPS would be 3 months or less. Among these elective TIPS patients, 173 had the procedure for prevention of variceal rebleeding and 58 for treatment of refractory ascites. Death related to liver disease occurred in 110 patients, 70 within 3 months. Cox proportional-hazards regression identified serum concentrations of bilirubin and creatinine, international normalized ratio for prothrombin time (INR), and the cause of the underlying liver disease as predictors of survival in patients undergoing elective TIPS, either for prevention of variceal rebleeding or for treatment of refractory ascites. These variables can be used to calculate a risk score (R) for patients undergoing elective TIPS. Patients with R > 1.8 had a median survival of 3 months or less. This model was superior to both the Child-Pugh classification, as well as the Child-Pugh score, in predicting survival. Using logistic regression and the same variables, we also developed a nomogram that indicates which patients survive less than 3 months. Finally, the mo…
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Existing EHRs suffer from bias because of how patients and their care are captured.
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Many large databases have fundamental bias and do not reflect the target population of patient being treated.
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The rapid advances in AI, and in particular the release of publicly available generative AI applications leveraging advanced large language models, have greatly accelerated discussions considering the promises and pitfalls related to AI deployment in society and healthcare.
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References 30 · Cited by 2,893
- Authors
- Malinchoc, M., Kamath, P. S., Gordon, F. D., Peine, C. J., Rank, J., & ter Borg, P. C. J.
- Affiliations
- Mayo Clinic (US)
- Beth Israel Deaconess Medical Center (US)
- Hennepin County Medical Center (US)
- University of Minnesota (US)
- Corresponding author
- Kamath, Patrick S.
- Venue
- Hepatology
- Published
- 2000-04
- Volume
- 31
- Issue
- 4
- Pages
- 864-871
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W2162322495
- Cited by
- 2,893
- References
- 30
- Citations by year
- 2026: 83 · 2025: 94 · 2024: 152 · 2023: 147 · 2022: 152 · 2021: 156 · 2020: 165 · 2019: 134 · 2018: 138 · 2017: 146 · 2016: 154 · 2015: 146 · 2014: 140 · 2013: 129 · 2012: 139
- FWCI
- 28.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK 34238, R01DK034238)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- transjugular intrahepatic portosystemic shunt, survival prediction, liver-related mortality, refractory ascites, Child-Pugh score, risk score, nomogram, serum bilirubin, serum creatinine, international normalized ratio, underlying liver disease
- MeSH terms
- Adult, Aged, Analysis of Variance, Ascites, Bacterial Infections, Bilirubin, Creatinine, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Mathematics, Middle Aged, Models, Biological, Peritonitis, Prothrombin Time, Risk Factors, Survival Rate, Liver Transplantation, Portasystemic Shunt, Transjugular Intrahepatic
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