title: A Standardized Assessment of Functional Disability Predicts 1-year Mortality in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt for Refractory Ascites.
abstract: OBJECTIVE
  To determine the association between functional disability and mortality after transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  BACKGROUND
  TIPS is a common therapeutic procedure for cirrhotic patients with refractory ascites. The conventional metric for periprocedure risk stratification is the model for end-stage liver disease (MELD), which uses biochemical parameters to predict post-TIPS mortality. It does not account for functional disability.
  
  
  METHODS
  This is a retrospective cohort study of 83 patients admitted at an academic liver transplant center with cirrhosis and refractory ascites for the purpose of TIPS placement. We assessed the association of patients' reported activities of daily living (ADL) on a scale of 1 to 21 before TIPS with a primary outcome of 1-year mortality. Multivariable regression to adjust for MELD and Child class was performed.
  
  
  RESULTS
  A higher ADL score or functional independence, was associated with decreased 1-year mortality when modeled as both a continuous variable [odds ratio (OR), 0.80; 95% confidence interval (CI), 0.66-0.97; P=0.02) and a dichotomous variable (ADL 21 vs. <21; OR, 0.21; 95% CI, 0.05-0.70; P=0.01). After adjusting for MELD and Child class, functional independence was associated with decreased 1-year transplant-free mortality (OR, 0.22; 95% CI, 0.05-0.77; P=0.02). An ADL score consistent with dependence (<21) was significantly associated with a 3.40-day (95% CI, 1.76-5.04) longer hospital stay, adjusting for MELD and Child class (P<0.0001).
  
  
  CONCLUSIONS
  Functional disability is a predictor of post-TIPS mortality and length of stay after controlling for MELD.
authors.affiliation: *Department of Medicine †Department of Radiology, Division of Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Grunwald
authors.forename: Elliot B
authors.initials: EB
authors.lastname: Tapper
authors.forename: Zhenghui Gordon
authors.initials: ZG
authors.lastname: Jiang
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
authors.forename: Raza
authors.initials: R
authors.lastname: Malik
mesh_terms: D000203:Activities of Daily Living; D001201:Ascites / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies