CLIF-C AD score predicts survival benefit from pre-emptive TIPS in individuals with Child-Pugh B cirrhosis and acute variceal bleeding
Yong Lv,
Wei Bai,
Xuan Zhu,
Hui Xue,
Jianbo Zhao,
Yuzheng Zhuge,
Junhui Sun,
Chunqing Zhang,
Pengxu Ding,
Zaibo Jiang,
Xiaoli Zhu,
Weixin Ren,
Yingchun Li,
Kewei Zhang,
Wenguang Zhang,
Kai Li,
Zhengyu Wang,
Bohan Luo,
Xiaomei Li,
Zhiping Yang,
Qiuhe Wang,
Wengang Guo,
Dongdong Xia,
Changbing Yang,
Yanglin Pan,
Zhanxin Yin,
Daiming Fan,
Guohong Han
Affiliations
Yong Lv
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Military Medical Innovation Center, Fourth Military Medical University, Xi’an, China
Wei Bai
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China
Xuan Zhu
Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China
Hui Xue
Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
Jianbo Zhao
Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
Yuzheng Zhuge
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
Junhui Sun
Hepatobiliaryand Pancreatic Intervention Center, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Chunqing Zhang
Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
Pengxu Ding
Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
Zaibo Jiang
Department of Interventional Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Xiaoli Zhu
Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
Weixin Ren
Department of Interventional Radiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
Yingchun Li
Department of Interventional Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, China
Kewei Zhang
Department of Vascular Surgery, Henan Provincial People's Hospital, Zhengzhou, China
Wenguang Zhang
Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
Kai Li
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Zhengyu Wang
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China
Bohan Luo
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China
Xiaomei Li
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China
Zhiping Yang
State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Qiuhe Wang
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Wengang Guo
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China
Dongdong Xia
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China
Changbing Yang
Military Medical Innovation Center, Fourth Military Medical University, Xi’an, China
Yanglin Pan
State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Zhanxin Yin
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China
Daiming Fan
State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
Guohong Han
Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China; Department of Liver Diseases and Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwestern University, Xi’an, China; Corresponding author. Address: Department of Liver Diseases and Digestive Interventional Radiology, Xi’an International Medical Center Hospital of Digestive Diseases, Northwest University, No,777 Xitai Road, High-tech Zone, Xi’an, 710100, China. Tel./fax: +86-29-68302656.
Background & Aims: Among individuals with Child-Pugh B cirrhosis and acute variceal bleeding (AVB), the Baveno VII workshop recommended pre-emptive TIPS in those with a Child-Pugh score of 8-9 and active bleeding at initial endoscopy (Child B8-9 + AB criteria). Nevertheless, whether this criterion is superior to the CLIF-Consortium acute decompensation score (CLIF-C ADs) remains unclear. Methods: Data on 1,021 consecutive individuals with Child-Pugh B cirrhosis and AVB from 13 university hospitals in China who were treated with pre-emptive TIPS (n = 297) or drug plus endoscopic treatment (n = 724) between 2010 to 2019 were retrospectively analysed. A competing risk regression model was used to compare the outcomes between the two groups after adjusting for confounders. The concordance-statistic for benefit (c-for-benefit) was used to evaluate a models’ ability to predict treatment benefit (risk difference between treatment groups). Results: Pre-emptive TIPS was associated with reduced mortality compared to drug plus endoscopic treatment (adjusted hazard ratio 0.62, 95% CI 0.44 to 0.88). A higher baseline CLIF-C AD score was associated with greater survival benefit (i.e., larger absolute mortality risk reduction). After adjusting for confounders, a survival benefit was observed in individuals with CLIF-C ADs ≥48 or Child-Pugh B8-9 with active bleeding, but not in those with CILF-C ADs <48, no active bleeding or Child-Pugh B7 with active bleeding. The c-for-benefit of CILF-C ADs for predicting survival benefit was higher than that of Child B8-9+AB criteria. Conclusions: In individuals with Child-Pugh B cirrhosis and AVB, CLIF-C ADs predicts survival benefit from pre-emptive TIPS and outperforms the Child B8-9+AB criteria. Prospective validation should be performed to confirm this result, especially for other aetiologies of cirrhosis. Impact and implications: In this study, among individuals with Child-Pugh B cirrhosis and acute variceal bleeding, the CLIF-Consortium acute decompensation (CLIF-C AD) score could predict the survival benefit from pre-emptive TIPS, with patients with higher CLIF-C AD scores benefiting more from pre-emptive TIPS. Furthermore, the CLIF-C AD score outperformed the Child B8-9 plus active bleeding criteria in terms of discriminating between those who obtained more benefit vs. less benefit from pre-emptive TIPS. Depending on prospective validation, the CLIF-C AD score could be used as the model of choice to determine who should undergo pre-emptive TIPS.
