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. 2024 May 27;16(5):1301-1310.
doi: 10.4240/wjgs.v16.i5.1301.

Development and validation of a predictive model for acute-on-chronic liver failure after transjugular intrahepatic portosystemic shunt

Wei Zhang  1 , Ya-Ni Jin  1 , Chang Sun  1 , Xiao-Feng Zhang  2 , Rui-Qi Li  1 , Qin Yin  1 , Jin-Jun Chen  2 , Yu-Zheng Zhuge  3
Affiliations

Development and validation of a predictive model for acute-on-chronic liver failure after transjugular intrahepatic portosystemic shunt

Wei Zhang et al. World J Gastrointest Surg. .

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a cause of acute-on-chronic liver failure (ACLF).

Aim: To investigate the risk factors of ACLF within 1 year after TIPS in patients with cirrhosis and construct a prediction model.

Methods: In total, 379 patients with decompensated cirrhosis treated with TIPS at Nanjing Drum Tower Hospital from 2017 to 2020 were selected as the training cohort, and 123 patients from Nanfang Hospital were included in the external validation cohort. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The prediction model was established based on the Akaike information criterion. Internal and external validation were conducted to assess the performance of the model.

Results: Age and total bilirubin (TBil) were independent risk factors for the incidence of ACLF within 1 year after TIPS. We developed a prediction model comprising age, TBil, and serum sodium, which demonstrated good discrimination and calibration in both the training cohort and the external validation cohort.

Conclusion: Age and TBil are independent risk factors for the incidence of ACLF within 1 year after TIPS in patients with decompensated cirrhosis. Our model showed satisfying predictive value.

Keywords: Acute-on-chronic liver failure; Influencing factor analysis; Nomogram; Risk prediction model; Transjugular intrahepatic portosystemic shunt.

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Conflict of interest statement

Conflict-of-interest statement: The Authors have no conflict of interest related to the manuscript.

Figures

Figure 1
Figure 1
Patients’ flowchart. TIPS: Transjugular intrahepatic portosystemic shunt; APASL: Asian Pacific Association for the Study of the Liver; ACLF: Acute-on-chronic liver failure.
Figure 2
Figure 2
The nomogram model for predicting the incidence of acute-on-chronic liver failure within 1 year after transjugular intrahepatic portosystemic shunt. ACLF: Acute-on-chronic liver failure; TBil: Total bilirubin; Na: Sodium.
Figure 3
Figure 3
Receiver operating characteristic curves and the calibration plots of the model for predicting the incidence of acute-on-chronic liver failure within 1 year after transjugular intrahepatic portosystemic shunt. A: In the training cohort, the area under the receiver operating characteristic curve (AUC) of the model was 0.800 [95% confidence interval (95%CI): 0.731-0.868]; B: In the validation cohort, the AUC of the model was 0.761 (95%CI: 0.607-0.914); C and D: The calibration plots in the training and validation cohorts. The predicted probability of the model was plotted on the x-axis; the actual probability was plotted on the y-axis. An ideal calibration plot is indicated by a 45° diagonal line. AUC: Area under the receiver operating characteristic curve; 95%CI: 95% confidence interval.
Figure 4
Figure 4
Receiver operating characteristic curves of the prediction model, risk score, and four liver function scoring systems for the prediction of the incidence of acute-on-chronic liver failure within 1 year after transjugular intrahepatic portosystemic shunt in the entire cohort. MELDs: Model for end-stage liver disease score; Child-Pughs: Child-Pugh score; CLIF-C ADs: Chronic Liver Failure Consortium acute decompensation score; MELD-Nas: MELD-Na score; AUROC: Area under the receiver operating characteristic curve; 95%CI: 95% confidence interval.
Figure 5
Figure 5
The prognosis between the acute-on-chronic liver failure group and the non-acute-on-chronic liver failure group. A: The Kaplan-Meier curve shows the probability of survival; B: The Kaplan-Meier curve shows the liver disease-related mortality rates; C: The Kaplan-Meier curve shows the rebleeding rates; D: The Kaplan-Meier curve shows the probability of stent stenosis. ACLF: Acute-on-chronic liver failure.
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