Emory Model (TIPS) Score
Understanding the Emory Model for TIPS
The Emory Model (TIPS) Score is a validated tool used to predict mortality risk in patients undergoing Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure. This scoring system helps clinicians assess the risk and make informed decisions about patient care.
What is TIPS?
TIPS is a procedure that creates a new pathway between the portal vein and hepatic vein in the liver. It's commonly performed to treat portal hypertension complications such as:
- Variceal bleeding
- Refractory ascites
- Hepatic hydrothorax
Risk Factors and Scoring
The Emory Model considers four key factors:
-
Emergent TIPS (+2 points)
- Emergency TIPS placement for uncontrolled variceal bleeding
- Strongest predictor of mortality (HR 5.1)
-
ALT Level (+1 point)
- > 100 IU/L
- Associated with poor outcomes (HR 2.5)
-
Bilirubin Level (+1 point)
- > 3.0 mg/dL
- Independent predictor of mortality (HR 2.6)
-
Pre-TIPS Encephalopathy (+1 point)
- Presence of hepatic encephalopathy before procedure
- Not related to bleeding episodes (HR 2.2)
Risk Categories
Based on the total score (0-5 points):
-
Low Risk (0 points)
- Better prognosis
- ~70% 1-year survival rate
-
Medium Risk (1-3 points)
- Intermediate prognosis
- ~43% 1-year survival rate
-
High Risk (4-5 points)
- Poor prognosis
- ~10% 1-year survival rate
- TIPS may not be appropriate, especially if transplant not an option
Clinical Applications
The Emory Model helps in:
- Patient selection for TIPS
- Risk stratification
- Informed decision-making
- Post-procedure monitoring planning
Important Considerations
- Score should be interpreted alongside other clinical findings
- Individual patient factors may affect outcomes
- Regular monitoring is essential post-procedure
- Consider alternative treatments for high-risk patients
When to Use
Consider calculating the Emory Model Score:
- Before planned TIPS procedure
- During emergency evaluations
- For risk assessment discussions
- During patient counseling
Limitations
This calculator:
- Provides estimates based on available data
- Should not replace clinical judgment
- May not account for all patient factors
- Works best as part of comprehensive evaluation
Tips for Accurate Results
- Use recent laboratory values
- Verify all input data
- Consider trending values
- Document pre-existing conditions
Start calculating now to better assess TIPS procedure risks!
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