Albumin and age as independent predictors of 1 year mortality in cirrhotic patients undergoing elective tips.
Mendiratta V, Mishra K, Abdulla H, and Venkat D. Albumin and age as independent predictors of 1 year mortality in cirrhotic patients undergoing elective tips. J Gen Intern Med 2018; 33(2):109.
J Gen Intern Med
Background: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is used for management of patients with complications related to portal hypertension. Mortality rates have been estimated to be between 48-90%, and thus, appropriate patient selection is critical. Currently, patient selection is based on clinical scoring models such as Child-Pugh and MELD to predict mortality. The purpose of this study was to identify potential factors which may predict higher mortality rates in patients undergoing elective TIPS procedure. Methods: After IRB approval, a HIPAA compliant retrospective search of the health system electronic medical database was performed. Any cirrhotic patient who underwent elective TIPS placement between 1/2004-6/2016 with at least 1 year follow-up was included, yielding 95 patients. Relevant data collected from medical record review included: patient demographics, TIPS indication, etiology of cirrhosis, albumin, platelets, pre-TIPS MELD, Child-Pugh scores, pre-and post-TIPS portosystemic gradient, and mortality at 3 and 12 months post-TIPS. Univariate two-group comparisons using independent two-group t-tests for continuous variables, and using chi-square tests for categorical variables. Results: 95 elective TIPS were performed in 38 females and 57 males with a mean age of 55. 24% (23/95) of patients died within 1 year post-procedure. Mean pre-TIPS MELD score for all patients was 13.5, mean pre-TIPS Child-Pugh score was 8.6, and mean pre-TIPS albumin was 2.8. Patients who died within 1 year of a TIPS procedure had a higher pre-procedure MELD score than those that lived (mean 14.6 vs 13.5), a statistically significant higher Child Pugh score (mean 9.4 vs 8.3 (p = 0.001)), a statistically significant lower albumin (mean 2.6 vs 2.9 (p = 0.036)) and a statistically significant higher age (mean 60.2 vs 55 (p=0.024)). Conclusions: Our data is concordant with other studies which show that higher MELD and Child-Pugh scores results in a higher mortality rate in patients undergoing elective TIPS. Moreover, our analysis suggests the importance of albumin and age as independent predictors of mortality for patients undergoing elective TIPS procedure. In fact, an albumin of less than 2.7 suggests approximately 2.59 times greater likelihood for mortality within 1 year. Thus, the use of albumin and age as independent variables may help for improved patient selection in elective TIPS.