title: Serum bilirubin and platelet count: a simple predictive model for survival in patients with refractory ascites treated by TIPS.
abstract: OBJECTIVE
  Refractory ascites in patients with cirrhosis is associated with poor survival. TIPS is more effective than paracentesis for the prevention of recurrence of ascites but increases the risk of encephalopathy while survival remains unchanged. A more accurate selection of the patients might improve these results. The aim of the present study was to identify parameters of prognostic value for survival in patients with refractory ascites treated with TIPS.
  
  
  METHODS
  One hundred and five consecutive French patients with cirrhosis and refractory ascites treated with TIPS were used to assess parameters associated with 1-year survival. The model was then tested in two different cohorts: a local and prospective one including 40 patients from Toulouse, France, and an external one including 48 patients from Barcelona, Spain.
  
  
  RESULTS
  The actuarial rate of survival in the first 105 patients was 60% at 1 year. Using multivariate analysis, only lower bilirubin levels and higher platelet counts were independently associated with survival. The actuarial 1-year survival rate in patients with both a platelet count above 75×10(9)/L and a bilirubin level lower than 50 μmol/L [3mg/dl] was 73.1% as compared to 31.2%, in patients with a platelet count below 75×10(9)/L or a bilirubin level higher than 50 μmol/L. These results were confirmed in the two different validation cohorts.
  
  
  CONCLUSIONS
  The combination of a bilirubin level below 50 μmol/L and a platelet count above 75×10(9)/L is predictive of survival in patients with refractory ascites treated with TIPS. This simple score could be used at bedside to help choose the best therapeutic options.
authors.affiliation: Service d'Hepato-gastro-enterologie, Fédération Digestive, CHU Toulouse Purpan, 31059 Toulouse cedex, France. Bureau.c@chu-toulouse.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.forename: Sophie
authors.initials: S
authors.lastname: Métivier
authors.forename: Mario
authors.initials: M
authors.lastname: D'Amico
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Péron
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Juan Carlos Garcia
authors.initials: JC
authors.lastname: Pagan
authors.forename: Valérie
authors.initials: V
authors.lastname: Chabbert
authors.forename: Carine
authors.initials: C
authors.lastname: Chagneau-Derrode
authors.forename: Bogdan
authors.initials: B
authors.lastname: Procopet
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
authors.forename: Jaume
authors.initials: J
authors.lastname: Bosch
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Vinel
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000097:blood / Q000401:mortality / Q000601:surgery; D001663:Bilirubin / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000401:mortality / Q000601:surgery; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D016019:Survival Analysis
chemical_list: D001663:Bilirubin