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. 2022 Sep;67(9):4581-4589.
doi: 10.1007/s10620-021-07307-5. Epub 2021 Nov 19.

External Validation of the FIPS Score for Post-TIPS Mortality in a National Veterans Affairs Cohort

Sara E Chapin  1 , David S Goldberg  2 , David E Kaplan  3   4 , Nadim Mahmud  5   6   7   8
Affiliations

External Validation of the FIPS Score for Post-TIPS Mortality in a National Veterans Affairs Cohort

Sara E Chapin et al. Dig Dis Sci. 2022 Sep.

Abstract

Background: The Freiburg index of post-TIPS survival (FIPS) score was recently demonstrated to improve prediction of post-TIPS mortality relative to existing standards. As this score was derived from a German cohort over an extended time period, it is unclear if performance will translate well to other settings. This study aimed to externally validate the FIPS score in a large Veterans Affairs (VA) cohort over two separate eras of TIPS-related care.

Methods: This was a retrospective cohort study of patients with cirrhosis who underwent TIPS placement in the VA from 2008 to 2020. Cox regression models for post-TIPS survival were constructed using FIPS, MELD, MELD-Na, or CTP scores as predictors. Discrimination (Harrell's C) and calibration (joint tests of calibration curve slope and intercept) were evaluated for each score. A stratified analysis was performed for time periods between 2008-2013 and 2014-2020.

Results: The cohort of 1,274 patients was 97.3% male with mean age 60.9 years and mean MELD-Na 14. The FIPS score demonstrated the highest overall discrimination versus MELD, MELD-Na, and CTP (0.634 vs. 0.585, 0.626, 0.612, respectively). However, in the modern treatment era (2014-2020), the FIPS score performed similarly to MELD-Na. Additionally, the FIPS score demonstrated poor calibration at one-month and six-month post-TIPS timepoints (joint p = 0.04 and 0.004, respectively). MELD, MELD-Na, and CTP were well-calibrated at each timepoint (each joint p > 0.05).

Conclusion: The FIPS score performed similarly to MELD-Na in the modern TIPS treatment era and demonstrated regions of poor calibration. Future models derived with contemporary data may improve prediction of post-TIPS mortality.

Keywords: Cirrhosis; FIPS; MELD-Na; Prediction modeling; TIPS.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier Curves for Post-TIPS Survival A in Patients with High versus Low-Risk FIPS Scores and B by Era. * High-risk patients are designated by FIPS index ≥ 0.92, and low-risk patients with FIPS < 0.92
Fig. 2
Fig. 2
Time-Dependent AUC Values for Post-TIPS Mortality for FIPS, MELD, MELD-Na, and CTP. Panel A – Discrimination of scores for the overall cohort. Panel B – Discrimination of scores in the early treatment era (2013 and earlier). Panel C – Discrimination of scores in the modern treatment era (after 2013). Panel D – Discrimination of the FIPS score overall and in early and modern treatment eras
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