In:
Journal of Gastroenterology and Hepatology, Wiley, Vol. 38, No. 9 ( 2023-09), p. 1629-1636
Abstract:
Portosystemic shunt embolization (PSSE) is a promising treatment for hepatic encephalopathy (HEP) and gastric varix (GV) in cirrhotic patients with a spontaneous portosystemic shunt. However, PSSE may worsen portal hypertension causing hepatorenal syndrome, liver failure, and mortality. This study aimed to develop and validate a prognostic model that helps identify patients with a risk of poor short‐term survival after PSSE. Methods We included 188 patients who underwent PSSE for recurrent HEP or GV at a tertiary center in Korea. To develop a prediction model for 6‐month survival after PSSE, Cox proportional‐hazard model was used. The developed model was validated in a separate cohort of 184 patients from two other tertiary centers. Results In multivariable analysis, the 1‐year overall survival after PSSE was significantly associated with baseline levels of serum albumin, total bilirubin, and international normalized ratio (INR). We therefore developed the albumin‐bilirubin‐INR (ABI) score by assigning 1 point each for albumin 〈 3.0 g/dL, total bilirubin ≥ 1.5 mg/dL, and INR ≥ 1.5. Time‐dependent areas under the curve of the ABI score for predicting 3‐month and 6‐month survival were 0.85 and 0.85 in the development cohort and 0.83 and 0.78 in the validation cohort, indicating good discrimination performance. The ABI score showed a better discrimination and calibration performance than the model for end‐stage liver disease and the Child–Pugh scores, especially in high‐risk patients. Conclusions The ABI score is a simple prognostic model that helps decide whether to proceed with PSSE for the prevention of HEP or GV bleeding in patients with spontaneous portosystemic shunt.
Type of Medium:
Online Resource
ISSN:
0815-9319
,
1440-1746
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
2006782-3
