Editorial Note: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for managing complications of portal hypertension in cirrhosis, such as refractory ascites or secondary prevention of esophageal and gastric variceal bleeding. However, post-TIPS prognosis varies significantly among patients, with some experiencing further decompensation or acute-on-chronic liver failure (ACLF), severely impacting survival and quality of life. Accurately predicting post-TIPS risk has long been a critical challenge in clinical practice.Recently, an important study by the German Liver Cirrhosis Research Group (DGVS) introduced the Freiburg Index (FIPS), which integrates age, serum creatinine, bilirubin, and albumin levels to effectively identify high-risk patients undergoing TIPS. This study provides valuable clinical guidance for hepatologists worldwide, aiding in the development of personalized post-TIPS management strategies.
Study Overview and Key Findings
This retrospective study analyzed data from 1,359 cirrhotic patients treated at eight tertiary medical centers in Germany. All patients had undergone TIPS placement due to recurrent or refractory ascites or secondary prevention of variceal bleeding. The study stratified patients based on their FIPS scores and assessed their clinical outcomes post-TIPS.
- Primary endpoint: Further decompensation within 90 days post-TIPS
- Secondary endpoints: Development of ACLF within 90 days and one-year transplant-free survival
The results demonstrated a significantly higher cumulative incidence of further decompensation within 90 days in high-risk patients compared to low-risk patients (58% vs. 38%, P < 0.001). Furthermore, high-risk patients had a markedly higher probability of developing ACLF (18% vs. 8%, P = 0.008).
Additional analysis revealed that high-risk patients had significantly lower one-year transplant-free survival, with further decompensation and ACLF being the primary contributors to poor prognosis.
Clinical Implications and Future Perspectives
The research team emphasized that FIPS is not only a reliable predictor of post-TIPS survival risk but also a valuable tool for clinical decision-making. For FIPS high-risk patients, clinicians should carefully reassess the indication for TIPS and consider alternative treatment options such as liver transplantation. Additionally, enhanced post-TIPS monitoring and management are essential to prevent further decompensation and the onset of ACLF.
Dr. Dominik Bettinger, corresponding author of the study, remarked: “The development of FIPS provides a new tool for assessing post-TIPS risk, allowing us to design more personalized treatment plans. Moving forward, we will continue to explore the clinical applications of FIPS in hopes of bringing greater benefits to liver disease patients worldwide.”
Moreover, the study underscored the importance of alcohol cessation and chronic liver disease management. Findings revealed that patients who abstained from alcohol and received effective treatment for chronic liver disease had a significantly lower risk of further decompensation post-TIPS and experienced noticeable improvements in quality of life.
A Milestone in Post-TIPS Patient Management
The publication of this study marks a significant advancement in the management of post-TIPS patients, providing hepatologists with a more precise and personalized treatment approach. As further research and clinical experience accumulate, TIPS will continue to offer new hope for cirrhotic patients worldwide.
