P67 Assessment of prognostic scores in patients undergoing transjugular intrahepatic portosystemic shunts for ascites

<h3>Background and Aims</h3> Transjugular intrahepatic portosystemic shunts (TIPSS) are increasingly used for the management of portal hypertensive complications. Outcomes for patients undergoing TIPSS for the management of ascites over a 12-year period were reviewed to assess for predictors of mortality. <h3>Method</h3> Data was collected for patients undergoing TIPSS procedures at a tertiary transplant centre between April 2010 and September 2022. Statistical analyses used included t-tests and Mann-Whitney tests for comparison of continuous variables between groups and the Cox proportional hazards model to identify predictive factors for mortality. Patients were censored at the point of death, last known follow up or the date of transplantation. <h3>Results</h3> There were 279 TIPSS procedures and 62.7% of the patients were male with a mean age of 56.6 years. Alcohol was the most common aetiology (63.4%), followed by metabolic dysfunction- associated steatotic liver disease (14.3%) and hepatitis C infection (8.6%). The median baseline MELD was 11 (IQR 9–14). Following TIPSS, a total of 14% of patients were transplanted, 5 within 90 days and 24 within one year. Of the remaining patients, survival at 90 days and 12-months was 91.5% (237/259) and 74.5% (175/235) respectively. Of the documented causes of death, 68.1% were due to liver related causes and 13.9% due to sepsis. Baseline variables predictive at univariate analysis for 90-day survival included hypertension, diabetes, previous cardiac and smoking histories but only hypertension (aHR 3.780, 95% C.I. 1.628–8.776) remained significant at multivariable analysis. Multivariable analysis showed all prognostic scores assessed (MELD aHR 1.097, 95% C.I 1.037–1.159, MELDNa 1.059, 95% C.I. 1.011–1.109, GEMA aHR 1.074, 95% C.I. 1.010–1.143 and GEMANa aHR 1.060, 95% C.I 1.002–1.121) to be predictive for survival at 12-months alongside diabetes (aHR 1.740, 95% C.I 1.034–2.925), ‘non-alcohol or metabolic’ aetiologies (aHR 2.281, 95% C.I 1.146–4.538) and previous cardiac disease (aHR 2.497, 95% C.I 1.164–5.357). For overall mortality, although all prognostic scores were significant at univariate analysis only MELD (aHR 1.073, 95% C.I, 1.025–1.122), MELDNa (aHR 1.043, 95% C.I. 1.007–1.079) and GEMA (aHR 1.050, 95% C.I. 1.004–1.099) remained independently predictive at multivariable analysis. Clinical factors included age (aHR 1.022, 95% C.I.1.004–1.041), diabetes (aHR 1.448, 95% C.I.1.005–2.086) and platelet count (aHR 0.998, 95% C.I 0.995–1.000). <h3>Conclusion</h3> In this cohort of patients undergoing TIPSS for ascites, prognostic scores were not predictive of survival at three months, potentially relating to the small number of events, however were predictive of 12 month and overall mortality.