Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 629-637
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.629
Validation of prognostic indices in Egyptian Budd-Chiari syndrome patients: A single-center study
Mohammad Sakr, Sara M Abdelhakam, Soheir A Elsayed, Enas H Allam, Amir M Farid, Waleed Abdelmoaty, Azza M Hassan, Mohamed Shaker, Mohamed El-Gharib, Ahmed Eldorry
Mohammad Sakr, Sara M Abdelhakam, Soheir A Elsayed, Enas H Allam, Amir M Farid, Waleed Abdelmoaty, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Azza M Hassan, Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Mohamed Shaker, Mohamed El-Gharib, Ahmed Eldorry, Department of Radiodiagnosis and Interventional Radiology, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt
Author contributions: Sakr M and Eldorry A contributed equally to the work; Sakr M, Abdelhakam SM, Elsayed SA, Allam EH, Farid AM, Abdelmoaty W and Eldorry A designed the research; Sakr M, Abdelhakam SM, Farid AM, Shaker M, El-Gharib M and Eldorry A performed the research; Abdelhakam SM, Elsayed SA, Allam EH, Abdelmoaty W, Hassan AM, Shaker M and El-Gharib M contributed analytical tools; Sakr M, Abdelhakam SM, Hassan AM and Eldorry A analyzed the data; Abdelhakam SM, Farid AM and Abdelmoaty W wrote the paper.
Institutional review board statement: This study was reviewed and approved by Research Ethics Committee of Faculty of Medicine, Ain Shams University Institutional Review Board.
Informed consent statement: All study participants provided informed written consent for personal and medical data collection prior to study enrollment and each patient agreed to management via written consent.
Conflict-of-interest statement: None of the authors have any conflicts of interests or financial disclosures.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at saratropical@yahoo.com. The participants gave informed consent for the data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara M Abdelhakam, MD, Assistant Professor, Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Khalifa El-Maamon St., Abbassia, Cairo 11341, Egypt. saratropical@yahoo.com
Telephone: +20-100-1601548 Fax: +20-22-2598751
Received: October 13, 2016
Peer-review started: October 14, 2016
First decision: November 21, 2016
Revised: December 9, 2016
Accepted: December 21, 2016
Article in press: December 21, 2016
Published online: January 28, 2017
Abstract
AIM

To compare predictive ability of Budd-Chiari syndrome (BCS) prognostic indices (PIs) for one-year survival and Transjugular intrahepatic portosystemic shunt (TIPS) patency.

METHODS

This retrospective study enrolled 194 Egyptian patients with primary BCS who presented to the Budd-Chiari Study Group of Ain Shams University Hospital. Calculation of the available PIs was performed using Child-Pugh and model for end-stage liver disease scores, BCS-specific PIs (Clichy, New Clichy and Rotterdam) for all patients, and BCS-TIPS PI only for patients who underwent TIPS. The overall one-year survival rate and the one-year shunt patency rate for TIPS were reported.

RESULTS

The overall one-year survival rate was 69.6%, and the New Clichy PI revealed the best validity for its prediction at a cut-off value of 3.75, with sensitivity and specificity of 78% and 73.3%, respectively [area under receiver operating characteristic curve (AUC) = 0.806]. The one-year survival rate post-TIPS was 89.7%, and the BCS-TIPS score demonstrated validity for its prediction at a cut-off value of 3.92 (sensitivity and specificity were 71.4% and 64.5%, respectively) (AUC = 0.715). Logistic regression analysis revealed that the New Clichy PI (P = 0.030), high serum total bilirubin (P = 0.047) and low albumin (P < 0.001) were independent factors for predicting mortality within one year. The one-year shunt patency rate in TIPS was 80.2%, and none of the PIs exhibited significant validity for its prediction.

CONCLUSION

The New Clichy score could independently predict the one-year survival in Egyptian BCS patients.

Keywords: Budd-Chiari syndrome, Prognostic indices, New Clichy score, One-year survival, Transjugular intrahepatic portosystemic shunt

Core tip: We analyzed the predictive ability of Budd-Chiari syndrome (BCS) prognostic indices (PIs) for one-year overall survival and transjugular intrahepatic portosystemic shunt (TIPS) patency rate in 194 Egyptian patients. Calculation of the available PIs was performed using Child-Pugh and model for end-stage liver disease scores, BCS-specific PIs (Clichy, New Clichy and Rotterdam) for all patients, and BCS-TIPS PI only for patients who underwent TIPS. We found that the New Clichy score independently predicted one-year survival in Egyptian BCS patients.