Child-Na score: a predictive model for survival in cirrhotic patients with symptomatic portal hypertension treated with TIPS.
OBJECTIVE
Several models have been developed to predict survival in patients with cirrhosis undergoing TIPS; however, few of these models have gained widespread acceptance, especially in the era of covered stents. The aim of this study was to establish an evidence-based model for predicting survival after TIPS procedures.


METHODS
A total of 210 patients with cirrhosis treated with TIPS were considered in the study. We comprehensively investigated factors associated with one-year survival and developed a new predictive model using the Cox regression model.


RESULTS
In the multivariate analysis, the Child-Pugh score and serum sodium levels were independent predictors of one-year survival. A new score incorporating serum sodium into the Child-Pugh score was developed: Child-Na score. We compared the predictive accuracy of Child-Na score with that of other scores; only the Child-Na and MELD-Na scores had adequate predictive ability in patients with serum Na levels <138 mmol/L. The best Child-Na cut-off score (15.5) differentiated two groups of patients with distinct prognoses (one-year cumulative survival rates of 80.6% and 45.5%); this finding was confirmed in a validation cohort (n = 86). In a subgroup analysis stratifying patients by indication for TIPS, the Child-Na score distinguished patients with different prognoses.


CONCLUSIONS
Patients with variceal bleeding and a Child-Na score ≤15 had a better prognosis than patients with a score ≥16. Patients with refractory ascites and a Child-Na score ≥16 had a high risk of death after the TIPS procedures; caution should be used when treating these patients with TIPS.
Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Hui
H
Chen
Ming
M
Bai
Xingshun
X
Qi
Lei
L
Liu
Chuangye
C
He
Zhanxin
Z
Yin
Daiming
D
Fan
Guohong
G
Han
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D012964:Sodium / Q000097:blood*; D055815:Young Adult
D012964:Sodium