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A Novel Score for Predicting Long-Term Outcomes in Recanalisation-Treated Patients With Budd-Chiari Syndrome: A
Dongdong Xia1,2,3, Bohan Luo2,3, Qiuhe Wang2,4
1State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Insights
A new BCS-Recanalisation score aids in predicting outcomes for Budd-Chiari syndrome patients undergoing recanalisation. This score helps stratify patients into low, intermediate, and high-risk groups for better management.
Area of Science:
- Hepatology
- Interventional Radiology
- Medical Statistics
Background:
- Budd-Chiari syndrome (BCS) lacks a specific recanalisation model.
- Individualized long-term outcome prediction and risk stratification are needed for BCS patients.
Purpose of the Study:
- To develop and validate a novel prognostic score for BCS patients undergoing recanalisation.
- To compare the novel score with existing BCS prognostic models.
Main Methods:
- A cohort of 834 BCS patients undergoing recanalisation from six Chinese centers (January 2010 - May 2019) was analyzed.
- Cox multivariable regression and a 1000-times bootstrapped internal validation were employed.
- The developed score was compared with existing models like the Clichy score.
Main Results:
- The BCS-Recanalisation score, incorporating variceal bleeding history, ascites, albumin, creatinine, urea, WBC, and alkaline phosphatase, showed good discrimination (C-index: 0.74).
- Patients were stratified into low, intermediate, and high-risk groups with significantly different 5-year TIPS-free survival rates (92.2%, 84.7%, 67.8%).
- The score outperformed existing models in predicting TIPS-free survival and other outcomes.
Conclusions:
- The BCS-Recanalisation score provides accurate individualised outcome prediction and risk stratification for recanalisation-treated BCS patients.
- The score demonstrates potential for clinical application in managing BCS.
- External validation is recommended for future studies.
Background And Aims:
A recanalisation-specific model for Budd-Chiari syndrome (BCS) is lacking. We aimed to develop a novel score for individual long-term outcome prediction and risk stratification.
Methods:
Overall, 834 BCS patients undergoing recanalisation (566 received percutaneous transluminal angioplasty alone, and 268 with routine stenting) from January 2010 to May 2019 were included from six Chinese centres. The model was developed using Cox multivariable regression, internally validated through a 1000-times bootstrapped method, and compared its performance with existing BCS prognostic models, like the Clichy score.
Results:
During the median follow-up period of 58.0 months, 44 patients were converted to transjugular intrahepatic portosystemic shunt (TIPS), none underwent orthotopic liver transplantation (OLT) and 75 died. The final BCS-Recanalisation score incorporated: variceal bleeding history, degree of ascites, albumin, creatinine, urea, white blood cell count and Ln (alkaline phosphatase). The score outperformed other available models with good discrimination (C-index: 0.74) and calibration in predicting TIPS-free survival in the whole cohort, internal validation and most subgroups. Moreover, patients were categorised as low-risk (BCS-Recanalisation score ≤ 2.0), intermediate-risk (2.0-2.6) and high-risk (> 2.6) groups using X-tile software, with a 5-year TIPS-free survival rate of 92.2% (95% CI: 89.5%-95.0%), 84.7% (95% CI: 80.0%-90.0%) and 67.8% (95% CI: 59.4%-77.5%), respectively (p < 0.001). Significant differences were observed in overall survival, stenting-TIPS-free survival and competing-risk adjusted outcomes (restenosis, symptom recurrence, TIPS conversion) across risk strata.
Conclusions:
The BCS-Recanalisation score enables individualised outcome prediction and risk stratification in recanalisation-treated patients with BCS, showing promise for clinical application. Future external validation is required.
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