title: Prospective evaluation of a clinical score for 60-day mortality after transjugular intrahepatic portosystemic stent-shunt: Bonn TIPSS early mortality analysis.
abstract: OBJECTIVE
  Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is increasingly used to treat complications of portal hypertension, but proven tools for risk assessment of early mortality are lacking.
  
  
  METHODS
  The prospective evaluation of a new 60-day mortality score.
  
  
  METHODS
  In a tertiary medical centre, 30 consecutive TIPSS patients were analysed for early mortality predictors, such as Child-Pugh score, TIPSS urgency (elective: > or = 36 h or emergency: < 36 h after variceal bleeding), comorbidity (Acute Physiology and Chronic Health Evaluation [APACHE]-II) and clinical data. Main predictors (P< 0.01) in this group (group-1: Child-Pugh score 10A, 10B, 10C) were graded (1, 2 or 3 points representing low, medium and high risk, respectively) and summarized as a Bonn TIPSS early mortality (BOTEM) score. This score was then tested prospectively in the next 73 TIPSS patients (group-2: Child-Pugh score 14A, 42B, 17C).
  
  
  RESULTS
  Group 1 early mortality (30%) depended primarily on bilirubin (P< 0.005), APACHE-II (P < 0.001) and TIPSS urgency (P< 0.001). Added risk points (1, 2, 3) for bilirubin (< 3 mg/dl, 3-6 mg/dl, > 6 mg/dl, respectively), APACHE-II (< 10, 10-20, > 20 points, respectively) and urgency (elective, emergency, active bleeding, respectively) represented individual BOTEM score points. BOTEM was the best mortality predictor (P< 0.001); < or = / > 6 score points was the optimal cut-off, with 56% sensitivity, 100% specificity, 100% positive predictive value, 84% negative predictive value and 87% accuracy. In group 2, early mortality (8.2%) was again best predicted by BOTEM (P < 0.01) with the same cut-off and 67% sensitivity, 99% specificity, 80% positive predictive value, 97% negative predictive value and 96% accuracy.
  
  
  CONCLUSIONS
  BOTEM score based on bilirubin, comorbidity and TIPSS-urgency predicts rather reliably post-TIPSS 60-day mortality and might optimize TIPSS treatment.
authors.affiliation: Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
authors.forename: Karl August
authors.initials: KA
authors.lastname: Brensing
authors.forename: Peter
authors.initials: P
authors.lastname: Raab
authors.forename: Jochen
authors.initials: J
authors.lastname: Textor
authors.forename: Johannes
authors.initials: J
authors.lastname: Görich
authors.forename: Peter
authors.initials: P
authors.lastname: Schiedermaier
authors.forename: Holger
authors.initials: H
authors.lastname: Strunk
authors.forename: Dieter
authors.initials: D
authors.lastname: Paar
authors.forename: Michael
authors.initials: M
authors.lastname: Schepke
authors.forename: Thomas
authors.initials: T
authors.lastname: Sudhop
authors.forename: Ulrich
authors.initials: U
authors.lastname: Spengler
authors.forename: Hans
authors.initials: H
authors.lastname: Schild
authors.forename: Tilman
authors.initials: T
authors.lastname: Sauerbruch
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D001663:Bilirubin