Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Mar 22, 2023; 14(2): 34-45
Published online Mar 22, 2023. doi: 10.4291/wjgp.v14.i2.34
Novel CABIN score outperforms other prognostic models in predicting in-hospital mortality after salvage transjugular intrahepatic portosystemic shunting
Jake Krige, Eduard Jonas, Chanel Robinson, Steve Beningfield, Urda Kotze, Marc Bernon, Sean Burmeister, Christo Kloppers
Jake Krige, Eduard Jonas, Chanel Robinson, Urda Kotze, Marc Bernon, Sean Burmeister, Department of Surgical Gastroenterology, University of Cape Town Health Sciences Faculty, Cape Town 7925, Western Cape, South Africa
Steve Beningfield, Department of Radiology, University of Cape Town Health Sciences Faculty, Cape Town 7925, Western Cape, South Africa
Christo Kloppers, Department of Surgical Gastroenterology, University of Cape Town, Faculty of Health Sciences, Cape Town 7925, Western Cape, South Africa
Author contributions: Krige J, Jonas E and Robinson C designed the research study; Krige J, Jonas E, Robinson C and Kotze U collected the data and performed the research; Krige J, Jonas E, Robinson C, Kotze U, Beningfield S, Bernon M, Burmeister S, and Kloppers C analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study protocol was approved by the Human Research Ethics Committee (HREC Ref No. 120/2019) of the University of Cape Town and the research was conducted in accordance with the Declaration of Helsinki.
Informed consent statement: Since this was a retrospective observational study using existing anonymized data, the requirement for informed consent from the study participants was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors declare no conflict of interest.
Data sharing statement: Dataset available from the corresponding author at jej.krige@uct.ac.za.
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: Jake Krige, FACS, FRCS (Ed), MD, MSc, PhD, Full Professor, Department of Surgical Gastroenterology, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town 7925, Western Cape, South Africa. jej.krige@uct.ac.za
Received: November 29, 2022
Peer-review started: November 29, 2022
First decision: January 31, 2023
Revised: February 23, 2023
Accepted: March 10, 2023
Article in press: March 10, 2023
Published online: March 22, 2023
Processing time: 111 Days and 16.4 Hours
Abstract
BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is now established as the salvage procedure of choice in patients who have uncontrolled or severe recurrent variceal bleeding despite optimal medical and endoscopic treatment.

AIM

To analysis compared the performance of eight risk scores to predict in-hospital mortality after salvage TIPS (sTIPS) placement in patients with uncontrolled variceal bleeding after failed medical treatment and endoscopic intervention.

METHODS

Baseline risk scores for the Acute Physiology and Chronic Health Evaluation (APACHE) II, Bonn TIPS early mortality (BOTEM), Child-Pugh, Emory, FIPS, model for end-stage liver disease (MELD), MELD-Na, and a novel 5 category CABIN score incorporating Creatinine, Albumin, Bilirubin, INR and Na, were calculated before sTIPS. Concordance (C) statistics for predictive accuracy of in-hospital mortality of the eight scores were compared using area under the receiver operating characteristic curve (AUROC) analysis.

RESULTS

Thirty-four patients (29 men, 5 women), median age 52 years (range 31-80) received sTIPS for uncontrolled (11) or refractory (23) bleeding between August 1991 and November 2020. Salvage TIPS controlled bleeding in 32 (94%) patients with recurrence in one. Ten (29%) patients died in hospital. All scoring systems had a significant association with in-hospital mortality (P < 0.05) on multivariate analysis. Based on in-hospital survival AUROC, the CABIN (0.967), APACHE II (0.948) and Emory (0.942) scores had the best capability predicting mortality compared to FIPS (0.892), BOTEM (0.877), MELD Na (0.865), Child-Pugh (0.802) and MELD (0.792).

CONCLUSION

The novel CABIN score had the best prediction capability with statistical superiority over seven other risk scores. Despite sTIPS, hospital mortality remains high and can be predicted by CABIN category B or C or CABIN scores > 10. Survival was 100% in CABIN A patients while mortality was 75% for CABIN B, 87.5% for CABIN C, and 83% for CABIN scores > 10.

Keywords: Transjugular intrahepatic portosystemic shunt; Risk score; Portal hypertension; Variceal bleeding; Mortality

Core Tip: This study compared the performance of a new CABIN score with seven existing risk scores to predict in-hospital mortality after salvage transjugular intrahepatic portosystemic shunt (TIPS) placement in 34 patients with uncontrolled variceal bleeding after failed medical treatment and endoscopic intervention. Using concordance statistics for predictive accuracy of in-hospital mortality the novel 5 category CABIN score incorporating Creatinine, Albumin, Bilirubin, INR and Na outperformed the APACHE II, BOTEM, Child-Pugh, Emory, FIPS, MELD and MELD-Na scores when compared by area under the receiver operating characteristic curve (AUROC) analysis. Survival was 100% in CABIN A patients while mortality was 75% for CABIN B, 87.5% for CABIN C, and 83% for CABIN scores > 10.