title: Prognostic indices for Budd-Chiari syndrome: valid for clinical studies but insufficient for individual management.
abstract: OBJECTIVE
  Several prognostic indices (PIs) have been proposed for Budd-Chiari syndrome (BCS). However, patient characteristics, causal factors, and treatment outcomes have changed since these indices have been elaborated. Validation in a recent patient population and comparison of predictive accuracy between these PIs are needed.
  
  
  METHODS
  A database of 96 BCS patients diagnosed between 1995 and 2005 was analyzed. Cox survival models were fitted with time to liver transplantation or death, and time to invasive therapy or death, as end points. The prognostic values of known indices (Child-Pugh score, model for end-stage liver disease (MELD), Clichy, Rotterdam BCS index, New Clichy, and BCS-TIPS (transjugular intrahepatic portosystemic shunt)) at diagnosis were assessed in Cox models using the chi-square test, the Kent and O'Quigley measure of dependence, and unrestricted bootstrapping analysis. Areas under receiver operating characteristic curves (AUROCs) were built for both end points and compared.
  
  
  RESULTS
  All prognostic indices, except BCS-TIPS, were significant predictors of transplant-free and invasive therapy-free survival. However, only 31 and 37% of the variance in transplant-free and invasive therapy-free survival, respectively, were explained by the best performing indices. For transplant-free survival, AUROCs were < 0.70. For invasive therapy-free survival, AUROCs were < 0.80. For both end points, BCS-TIPS PI AUROCs were significantly lower than others.
  
  
  CONCLUSIONS
  Most PIs are valid for transplant-free survival and invasive therapy-free survival in a population of current BCS patients, and thus can be used for stratification in clinical studies. However, predictive accuracy is insufficient to be used for individual patients.
authors.affiliation: Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Hôpital Beaujon, AP-HP and INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, Université Paris 7-Denis-Diderot, Clichy, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Rautou
authors.forename: Rami
authors.initials: R
authors.lastname: Moucari
authors.forename: Sylvie
authors.initials: S
authors.lastname: Escolano
authors.forename: Dominique
authors.initials: D
authors.lastname: Cazals-Hatem
authors.forename: Cécile
authors.initials: C
authors.lastname: Denié
authors.forename: Carine
authors.initials: C
authors.lastname: Chagneau-Derrode
authors.forename: Claire
authors.initials: C
authors.lastname: Charpignon
authors.forename: Victor de
authors.initials: Vd
authors.lastname: Lédinghen
authors.forename: Marieke
authors.initials: M
authors.lastname: Grenouillet-Delacre
authors.forename: François
authors.initials: F
authors.lastname: Habersetzer
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Nousbaum
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Denninger
authors.forename: Dominique C
authors.initials: DC
authors.lastname: Valla
authors.forename: Aurélie
authors.initials: A
authors.lastname: Plessier