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Comparative Study
. 2025 Dec;57(1):2514082.
doi: 10.1080/07853890.2025.2514082. Epub 2025 Jun 6.

Comparing efficacy of different scoring models to predict hepatic encephalopathy after TIPS in cirrhotic patients

Xin-Jian Xu  1 , Liang Yin  2 , Yi-Jiang Zhu  2 , Dong Lu  2 , Xiang-Zhong Huang  1 , Wei-Fu Lv  2 , Chun-Ze Zhou  2 , De-Lei Cheng  2
Affiliations
Comparative Study

Comparing efficacy of different scoring models to predict hepatic encephalopathy after TIPS in cirrhotic patients

Xin-Jian Xu et al. Ann Med. 2025 Dec.

Abstract

Background: Assessing hepatic encephalopathy (HE) risk post-transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients is crucial. This study compares the predictive performance of Child-Pugh and Model for End-Stage Liver Disease (MELD), CLIFC-AD and Freiburg index of post-TIPS survival (FIPS) scores for overt and severe HE. To compare the predictive value of Child-Pugh, MELD, CLIFC-AD and FIPS scores for overt and severe HE post-TIPS in cirrhotic patients.

Materials and methods: We retrospectively analysed data from 406 cirrhotic TIPS patients (January 2017-January 2021). Scoring models were assessed for differentiation (C-index), calibration, clinical utility and overall performance at 1, 3, 6 and 12 months post-TIPS.

Results: Predictive performance for overt HE post-TIPS was low across models. FIPS had superior predictive ability for severe HE at 1 and 12 months post-TIPS (C-index: 0.781, 0.705). FIPS and CLIFC-AD showed good predictive capacity for severe HE in sarcopenic patients at 1 and 12 months (FIPS: C-index 0.863, 0.757; CLIFC-AD: C-index 0.748, 0.732). FIPS had the highest hazard ratio for severe HE (HR = 3.520, 95% CI: 2.134-5.807) and CLIFC-AD for overt HE (HR = 2.132, 95% CI: 1.581-2.874).

Conclusion: FIPS and CLIFC-AD scores demonstrate significant predictive ability for severe HE post-TIPS, particularly in sarcopenic patients.

Keywords: CLIFC-AD score; Child-Pugh score; FIPS score; MELD score; TIPS; hepatic encephalopathy.

Plain language summary

The study compares Child-Pugh, MELD, CLIFC-AD and FIPS scores for predicting hepatic encephalopathy post-TIPS.FIPS excels in predicting post-TIPS severe hepatic encephalopathy.FIPS and CLIFC-AD scores effectively predict severe hepatic encephalopathy in sarcopenic patients.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flowchart of patient selection.
Figure 2.
Figure 2.
Performance of the four scores in predicting overt HE after TIPS procedure over time. (A) Time-dependent C-index evaluating discrimination. (B) Time-dependent brier score evaluating calibration. (C) Time-dependent R2 evaluating overall performance. (D) Decision curve analysis evaluating net benefit at 12 months after TIPS placement. CLIFC-AD: CLIF consortium acute decompensation; FIPS: Freiburg index of post-TIPS survival; MELD: model for end-stage liver disease; TIPS: transjugular intrahepatic portosystemic shunt.
Figure 3.
Figure 3.
Performance of the four scores in predicting severe HE after TIPS procedure over time. (A) Time-dependent C-index evaluating discrimination. (B) Time-dependent Brier score evaluating calibration. (C) Time-dependent R2 evaluating overall performance. (D) Decision curve analysis evaluating net benefit at 12 months after TIPS placement. CLIFC-AD: CLIF consortium acute decompensation; FIPS: Freiburg index of post-TIPS survival; MELD: model for end-stage liver disease; TIPS: transjugular intrahepatic portosystemic shunt.
Figure 4.
Figure 4.
Performance of the four scores in predicting HE after TIPS procedure over time in the sarcopenic (Sa) and non-sarcopenic (non-Sa) patients. (A) Time-dependent C-index evaluating discrimination of overt HE in the non-Sa group. (B) Time-dependent C-index evaluating discrimination of overt HE in the Sa group. (C) Time-dependent C-index evaluating discrimination of severe HE in the non-Sa group. (D) Time-dependent C-index evaluating discrimination of severe HE in the Sa group. CLIFC-AD: CLIF consortium acute decompensation; FIPS: Freiburg index of post-TIPS survival; MELD: model for end-stage liver disease; TIPS: transjugular intrahepatic portosystemic shunt.
Figure 5.
Figure 5.
Comparison of the cumulative incidence of overt hepatic encephalopathy after TIPS procedure between high-risk and low-risk groups determined by four scoring models. (A) Child-Pugh score (cutoff: 7). (B) MELD score (cutoff: 8). (C) CLIFC-AD score (cutoff: 58.96). (D) FIPS score (cutoff: −0.91). CLIFC-AD: CLIF consortium acute decompensation; FIPS: Freiburg index of post-TIPS survival; MELD: model for end-stage liver disease; TIPS: transjugular intrahepatic portosystemic shunt.
Figure 6.
Figure 6.
Comparison of the cumulative incidence of severe hepatic encephalopathy after TIPS between high-risk and low-risk groups determined by four scoring models. (A) Child-Pugh score (cutoff: 7). (B) MELD score (cutoff: 11). (C) CLIFC-AD score (cutoff: 58.70). (D) FIPS score (cutoff: −0.97). CLIFC-AD: CLIF consortium acute decompensation; FIPS: Freiburg index of post-TIPS survival; MELD: model for end-stage liver disease; TIPS: transjugular intrahepatic portosystemic shunt.
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