Zhang W, Jin YN, Sun C, Zhang XF, Li RQ, Yin Q, Chen JJ, Zhuge YZ. Development and validation of a predictive model for acute-on-chronic liver failure after transjugular intrahepatic portosystemic shunt. World J Gastrointest Surg 2024; 16(5): 1301-1310 [PMID: 38817303 DOI: 10.4240/wjgs.v16.i5.1301]
Corresponding Author of This Article
Yu-Zheng Zhuge, MD, PhD, Professor, Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 321 Zhongshan Road, Nanjing 210000, Jiangsu Province, China. yuzheng9111963@aliyun.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wei Zhang, Ya-Ni Jin, Chang Sun, Rui-Qi Li, Qin Yin, Yu-Zheng Zhuge, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing 210000, Jiangsu Province, China
Xiao-Feng Zhang, Jin-Jun Chen, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China
Co-first authors: Wei Zhang and Ya-Ni Jin.
Co-corresponding authors: Jin-Jun Chen and Yu-Zheng Zhuge.
Author contributions: Zhang W and Jin YN contributed equally to this manuscript; Zhang W and Jin YN contributed to study conception and design; Sun C, Zhang XF, Li RQ, and Yin Q contributed to data acquisition; Sun C and Zhang XF contributed to analysis and interpretation of data; Zhang W and Jin YN contributed to manuscript writing, critical revision of the manuscript, and statistical analysis; Chen JJ and Zhuge YZ contributed to supervision and project administration; and all authors have read and approved the final manuscript.
Supported bythe Special Fund for Clinical Research of Nanjing Drum Tower Hospital, No. 2021-LCYJ-PY-01.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The Affiliated Drum Tower Hospital of Nanjing University Medical School (Approval No. 2022-596-02).
Informed consent statement: All study participants provided verbal informed consent before study enrollment.
Conflict-of-interest statement: The Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Zheng Zhuge, MD, PhD, Professor, Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 321 Zhongshan Road, Nanjing 210000, Jiangsu Province, China. yuzheng9111963@aliyun.com
Received: January 17, 2024 Revised: April 21, 2024 Accepted: April 26, 2024 Published online: May 27, 2024 Processing time: 126 Days and 19.4 Hours
Abstract
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) is a cause of acute-on-chronic liver failure (ACLF).
AIM
To investigate the risk factors of ACLF within 1 year after TIPS in patients with cirrhosis and construct a prediction model.
METHODS
In total, 379 patients with decompensated cirrhosis treated with TIPS at Nanjing Drum Tower Hospital from 2017 to 2020 were selected as the training cohort, and 123 patients from Nanfang Hospital were included in the external validation cohort. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The prediction model was established based on the Akaike information criterion. Internal and external validation were conducted to assess the performance of the model.
RESULTS
Age and total bilirubin (TBil) were independent risk factors for the incidence of ACLF within 1 year after TIPS. We developed a prediction model comprising age, TBil, and serum sodium, which demonstrated good discrimination and calibration in both the training cohort and the external validation cohort.
CONCLUSION
Age and TBil are independent risk factors for the incidence of ACLF within 1 year after TIPS in patients with decompensated cirrhosis. Our model showed satisfying predictive value.
Core Tip: Previous studies have proposed several models for predicting the prognosis of patients with acute-on-chronic liver failure (ACLF). However, to date, no such prediction model exists for forecasting the occurrence of ACLF following transjugular intrahepatic portosystemic shunt (TIPS). This study provides an internally and externally validated nomogram model, as well as an easy-to-use risk score scale for predicting the risk of ACLF within 1 year after TIPS. This information could enable physicians to effectively communicate the risks and benefits of the procedure to patients, facilitating shared decision-making.
