Novel CABIN score outperforms other prognostic models in predicting in-hospital mortality after salvage transjugular intrahepatic portosystemic shunting

Table 1 Demographic, clinical characteristics and risk prediction scores of 34 patients undergoing salvage transjugular intrahepatic portosystemic shunt, n %

Variable	Total cohort (n = 34)	Survived (n = 24)	In-hospital death (n = 10)	P value
Demographics
Age (mean ± SD)	52 ± 11.6	50 ± 10.5	57 ± 12.9	0.107
Sex
Male	29 (85)	22 (92)	7 (70)	0.104
Female	5 (15)	2 (8)	3 (30)
Cause of cirrhosis
Alcohol related	22 (65)	15 (63)	7 (70)	0.938
Non-alcohol related	12 (35)	9 (37)	3 (30)
Child-Pugh grade
A	3 (9)	3 (12)	0	0.022
B	19 (56)	16 (67)	3 (30)
C	12 (35)	5 (20)	7 (70)
Risk prediction scores
APACHE II (mean ± SD)	13.4 ± 4.7	11.4 ± 3.3	18.3 ± 3.8	0.196
BOTEM (mean ± SD)	5.4 ± 1.1	5.0 ± 0.9	6.3 ± 0.7	0.964
CABIN (mean ± SD)	10.9 ± 5.0	8.3 ± 1.8	17.0 ± 3.8	0.133
CHILD-PUGH (mean ± SD)	8.9 ± 1.8	8.2 ± 1.8	10.6 ± 2.0	0.001
EMORY (mean ± SD)	3.2 ± 0.9	2.8 ± 0.7	4.3 ± 0.5	0.497
FIPS (mean ± SD)	-0.3 ± 0.9	-0.6 ± 0.9	0.5 ± 0.5	0.205
MELD (mean ± SD)	15.0 ± 6.2	13 ± 4.8	19.8 ± 6.7	0.007
MELD-Na (mean ± SD)	16.9 ± 7.4	14 ± 5.3	23.9 ± 7.1	< 0.001

SD: Standard deviation; APACHE II: Acute physiology and chronic health evaluation II; BOTEM: Bonn TIPS early mortality; CABIN: Creatinine, Albumin, Bilirubin, INR, Sodium score; FIPS: Freiburg index of post-TIPS survival; MELD: Model for end-stage liver disease; MELD-Na: Model for end-stage liver disease sodium.

Table 2 Performance of various risk prediction scores in predicting in-hospital death following salvage transjugular intrahepatic portosystemic shunt

	In-hospital deaths
	AUC	STD error	P value	95% confidence interval
APACHE II	0.948	0.035	0	0.879–1.000
BOTEM	0.877	0.059	0.001	0.762–0.992
CABIN	0.967	0.028	0	0.912–1.000
CHILD-PUGH	0.802	0.084	0.006	0.638–0.967
EMORY	0.942	0.038	0	0.868–1.000
FIPS	0.892	0.055	0	0.783–1.000
MELD	0.792	0.082	0.008	0.631–0.952
MELD Na	0.865	0.077	0.001	0.713–1.000

AUC: Area under the curve; SD: standard deviation; APACHE II: Acute physiology and chronic health evaluation II; BOTEM: Bonn TIPS early mortality; CABIN: Creatinine albumin bilirubin INR sodium score; FIPS: Freiburg index of post-TIPS survival; MELD: Model for end-stage liver disease; MELD-Na: Model for end-stage liver disease sodium.

Table 3 Published series of salvage transjugular intrahepatic portosystemic shunt for uncontrolled variceal bleeding

Ref.	Country	No. of patients	C-P grade A/B/C	Initial control of bleeding %	30-d mortality %	Persistent/Recurrent rebleeding	Survival %	Prognostic factors
Azoulay et al[22], 2001	France	58	3/8/47	90	29	17	51.7 (12 mo)	Sepsis, vasoactive drugs, balloon tamponade
Bañares et al[23], 1998	Spain	56	11/22/23	95	28	22 (1 mo)	72 (30 d)	Ascites, HE, albumin
Barange et al[24], 1999	France	32	3/14/15	90	25	14	75 (30 d)	ND
Bizollon et al[25], 2001	France	28	0/11/17	96	25 (40 d)	18	52 (2 yr)	↑Creatinine, ↑bilirubin
Casadaban et al[26], 2015	United States	101	2/46/52	89	31	21	44 (12 mo)	↑Bilirubin, ↑creatinine, ↑INR, non-alcoholic liver disease
Chau et al[27], 1998	England	84	4/17/63	98	34	30 (30 d)	66 (30 d)	ND
Encarnacion et al[28], 1995	United States	64	2/32/31	98	19	29 (6 mo)	56 (12 mo)	Haemodynamic instability
Gazzera et al[29], 2012	Italy	82	ND	94	25.6	13.4	74.4 (30d)	Child-Pugh C, ↑creatinine, ↑PT
Gerbes et al[30], 1998	Germany	11		91	27	27	73 (12 mo)	ND
Helton et al[31], 1993	United States	23	0/15/18	74	56 (in hospital)	39	ND	Emergency TIPS, active bleeding
Hermie et al[32], 2018	Belgium	32	ND/ND/14	97	31	0	69	MELD > 19, Haemodynamic instability
Jabbour et al[33], 1996	United States	25	ND/ND/8	96	44	ND	56 (30 d)	Child-Pugh C, urgent TIPS
Jalan et al[34], 1995	Scotland	19	3/3/13	100	42	15.6	58 (30 d)	Liver failure, sepsis
Maimone et al[36], 2019	England	144	11/55/78	ND	36 (6 wk)	29	64 (6 wk)	↑MELD, ↑Child-Pugh score
Le Moine et al[35], 1994	Belgium	24	3/13/9	96	17	25	29 (5 mo)	ND
McCormick et al[37], 1994	England	20	1/7/12	100	60 (40 d)	40	30	ND
Patch et al[38], 1998	England	54	5/20/29	91	48 (6 wk)	11	53 (6 mo)	Ventilation, ↑WBC, platelets, ↑creatinine
Rubin et al[39], 1995	United States	49	3/23/23	84	40%	16	ND	C-P grade C, APACHE II > 18
Sanyal et al[40], 1996	United States	30	1/7/22	100	37	7	60 (6 wk)	> 70 yr, bilirubin >6 mg/dL, creatinine > 3 mg/dL, HE, ARDS
Tyburski et al[41], 1997	United States	33	0/5/28	ND	27	15	58 (12 mo)	Albumin < 2.5 g/dL, bilirubin > 3 mg/dL, PT > 15 s
Tzeng et al[42], 2009	Taiwan	107	ND	ND	28	ND	50 (12 mo)	C-P score > 11, MELD > 20
Zhu et al[43], 2019	China	58	5/36/7	91.2	12.3 (6 wk)	10.5 (6 wk)	81.8 (12 mo)	Ventilation, ICU

APACHE: Acute Physiology and Chronic Health Evaluation; ARDS: Adult Respiratory Distress Syndrome; C-P: Child-Pugh; INR: International normalized ratio; TIPS: Transjugular intrahepatic portosystemic shunt; MELD: Model for end-stage liver disease; HE: Hepatic encephalopathy; ND: No data; ICU: Intensive care unit; WBC: White blood cells.