A Novel Score for Predicting Long‐Term Outcomes in Recanalisation‐Treated Patients With Budd‐Chiari Syndrome: A Multicentre Study

ABSTRACT Background and Aims A recanalisation‐specific model for Budd‐Chiari syndrome (BCS) is lacking. We aimed to develop a novel score for individual long‐term outcome prediction and risk stratification. Methods Overall, 834 BCS patients undergoing recanalisation (566 received percutaneous transluminal angioplasty alone, and 268 with routine stenting) from January 2010 to May 2019 were included from six Chinese centres. The model was developed using Cox multivariable regression, internally validated through a 1000‐times bootstrapped method, and compared its performance with existing BCS prognostic models, like the Clichy score. Results During the median follow‐up period of 58.0 months, 44 patients were converted to transjugular intrahepatic portosystemic shunt (TIPS), none underwent orthotopic liver transplantation (OLT) and 75 died. The final BCS‐Recanalisation score incorporated: variceal bleeding history, degree of ascites, albumin, creatinine, urea, white blood cell count and Ln (alkaline phosphatase). The score outperformed other available models with good discrimination (C‐index: 0.74) and calibration in predicting TIPS‐free survival in the whole cohort, internal validation and most subgroups. Moreover, patients were categorised as low‐risk (BCS‐Recanalisation score ≤ 2.0), intermediate‐risk (2.0–2.6) and high‐risk (> 2.6) groups using X‐tile software, with a 5‐year TIPS‐free survival rate of 92.2% (95% CI: 89.5%–95.0%), 84.7% (95% CI: 80.0%–90.0%) and 67.8% (95% CI: 59.4%–77.5%), respectively ( p < 0.001). Significant differences were observed in overall survival, stenting‐TIPS‐free survival and competing‐risk adjusted outcomes (restenosis, symptom recurrence, TIPS conversion) across risk strata. Conclusions The BCS‐Recanalisation score enables individualised outcome prediction and risk stratification in recanalisation‐treated patients with BCS, showing promise for clinical application. Future external validation is required.