title: Rotterdam score predicts early mortality in Budd-Chiari syndrome, and surgical shunting prolongs transplant-free survival.
abstract: BACKGROUND
  Budd-Chiari syndrome carries significant mortality, but factors predicting this outcome are uncertain.
  
  
  OBJECTIVE
  To determine factors associated with 3-month mortality and compare outcomes after surgical shunting or liver transplantation.
  
  
  METHODS
  From 1985 to 2008, 51 patients with Budd-Chiari syndrome were identified.
  
  
  RESULTS
  By logistic regression analysis, features associated with higher risk of 3-month mortality were Rotterdam class III, Clichy >6.6, model for end-stage liver disease (MELD) >20 and Child-Pugh C. Rotterdam class III had the best performance to discriminate 3-month mortality with sensitivity of 0.89 and specificity of 0.63, whereas Clichy >6.60 had sensitivity of 0.78 and specificity of 0.69; MELD >20 had sensitivity of 0.78 and specificity of 0.75 and Child-Pugh C had sensitivity of 0.67 and specificity of 0.72. Eighteen patients underwent surgical shunts and 14 received liver transplantation with no significant differences in survival (median survival 10 +/- 3 vs. 8 +/- 2 years; log-rank, P = 0.9).
  
  
  CONCLUSIONS
  Rotterdam score is the best discrimination index for 3-month mortality in Budd-Chiari syndrome and should be used preferentially to determine treatment urgency. Surgical shunts constitute an important therapeutic modality that may help save liver grafts and prolong transplantation-free survival in a selected group of patients with Budd-Chiari syndrome.
authors.affiliation: University of Alberta, Edmonton, AB, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Montano-Loza
authors.forename: P
authors.initials: P
authors.lastname: Tandon
authors.forename: N
authors.initials: N
authors.lastname: Kneteman
authors.forename: R
authors.initials: R
authors.lastname: Bailey
authors.forename: V G
authors.initials: VG
authors.lastname: Bain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000401:mortality* / Q000601:surgery; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult