Serum bilirubin and platelet count: A simple predictive model for survival in patients with refractory ascites treated by TIPS

Background & Aims Refractory ascites in patients with cirrhosis is associated with poor survival. TIPS is more effective than para-centesis for the prevention of recurrence of ascites but increases the risk of encephalopathy while survival remains unchanged. A more accurate selection of the patients might improve these results. The aim of the present study was to identify parameters of prognostic value for survival in patients with refractory ascites treated with TIPS. Methods One hundred and five consecutive French patients with cirrhosis and refractory ascites treated with TIPS were used to assess parameters associated with 1-year survival. The model was then tested in two different cohorts: a local and prospective one including 40 patients from Toulouse, France, and an external one including 48 patients from Barcelona, Spain. Results The actuarial rate of survival in the first 105 patients was 60% at 1 year. Using multivariate analysis, only lower bilirubin levels and higher platelet counts were independently associated with survival. The actuarial 1-year survival rate in patients with both a platelet count above 75 × 109 /L and a bilirubin level lower than 50 μmol/L [3 mg/dl] was 73.1% as compared to 31.2%, in patients with a platelet count below 75 × 109 /L or a bilirubin level higher than 50 μmol/L. These results were confirmed in the two different validation cohorts. Conclusions The combination of a bilirubin level below 50 μmol/L and a platelet count above 75 × 109 /L is predictive of survival in patients with refractory ascites treated with TIPS. This simple score could be used at bedside to help choose the best therapeutic options.