Prognostic Value of Serial Alkaline Phosphatase-to-Albumin Ratio for Mortality After Transjugular Intrahepatic Portosystemic Shunt

Background: Prognostic assessment after transjugular intrahepatic portosystemic shunt (TIPS) remains challenging, and currently available scores are based mainly on pre-procedural variables. The alkaline phosphatase-to-albumin ratio (APAR) is a simple laboratory-derived marker that may provide additional prognostic information during the early post-TIPS period. Methods: This retrospective, single-center cohort study included 45 adults who underwent TIPS between February 2019 and December 2024. APAR was calculated at baseline, 48 h, and 1 week after the procedure. The primary outcome was one-year all-cause mortality; 90-day mortality was a secondary outcome. Prognostic performance was assessed by receiver operating characteristic (ROC) analysis, and associations with mortality were examined using Cox regression adjusted for age and baseline MELD score. Results: Within one year, 17 patients (37.8%) died; nine (20.0%) died within 90 days; and 22 (48.9%) died during overall follow-up. Median APAR was higher in patients who died within one year than in those alive at one year at baseline (5.98 vs. 3.89; p = 0.006), 48 h (10.79 vs. 3.78; p < 0.001), and 1 week (13.93 vs. 4.57; p < 0.001). ROC areas under the curve were 0.748 (95% CI, 0.578–0.893), 0.876 (0.748–0.964), and 0.873 (0.726–0.977), respectively. After adjustment for age and MELD, APAR remained associated with one-year mortality at baseline (hazard ratio [HR] 1.140; 95% CI, 1.049–1.238), 48 h (HR 1.225; 1.111–1.350), and 1 week (HR 1.193; 1.092–1.302). Conclusions: Serial APAR measurements were associated with one-year mortality after TIPS and may support early post-procedural risk assessment. Prospective multicenter validation is needed before clinical implementation.