studies

580A AASLD ABSTRACTS HEPATOLOGY, October, 2015
742
External validation of risk-stratification criteria in variceal
bleeding (ChildC-C1, MELD19) for the optimization
of the use of early TIPS
Salvador Augustin 1 , Juan Abraldes 2 , Lucio Amitrano 3 , Alba
Cachero 4 , Maria Anna Guardascione 3 , Jose Castellote 4 , Puneeta
Tandon 2 , Joan Genescà 1 ; 1 Hospital Universitari Vall d’Hebron,
Barcelona, Spain; 2 University of Alberta, Edmonton, AB, Canada;
3 Ospedale Cardarelli, Naples, Italy; 4 Hospital Bellvitge, Barcelona,
Spain
Early-TIPS is currently considered the treatment of choice for
high-risk cirrhotic patients with acute variceal bleeding (AVB).
However, recent studies have shown that the criteria used to
define high-risk should be refined. Several alternatives to early-TIPS
criteria (Child B + active bleeding and Child C) have
been proposed (Child C + creatinine >1 mg/dL, ChildCC1;
and MELD ≥19). The aim of the present study was to evaluate
the external validity of three classification rules (early-TIPS trial
criteria, ChildCC1 and MELD19) to identify high-risk patients
eligible for early-TIPS after an ABV. In the present observational,
retrospective, multicentric, international study, we
reviewed already collected data from 915 patients with AVB
from 4 centers which have previously published studies on the
issue (Naples-Italy; Alberta-Canada; Bellvitge and Vall d’Hebron-Spain).
All patients were treated with current standard of
care (drugs + ligation + antibiotics, with TIPS as rescue therapy).
Most patients had viral (39%) or alcohol (35%) cirrhosis
(12% had both). Median age was 59 (range 23-90), 64%
were male. 6-week mortality in the whole cohort was 18%.
Excluding patients non-eligible for TIPS (age ≥75, creatinine
≥3 mg/dL, Child score ≥14, HCC beyond Milano criteria or
portal thrombosis, N=673) mortality was 15%. Mortality for
Child class and each classification rule for these patients are
shown in the table. All 3 rules discriminated well high vs. lowrisk
patients. However, mortality for Child B was significantly
lower than for Child C patients, regardless of active bleeding.
Within Child C, mortality was overall high but significantly
different depending on baseline creatinine (23% in