Work

Comparative Prognostic Utility of Updated Model for End-Stage Liver Disease Scores for Prediction of Early Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation

Year: 2025

Type: article

Abstract: PURPOSE: To compare the performance of updated model for end-stage liver disease (MELD) systems with that of the original MELD score for predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: In this single-center retrospective study, 6 MELD variations were quantified in 553 patients (n = 332; 60% male; mean age, 55 years) who underwent TIPS creation between 1998 and 2023. Scoring systems included original MELD, MELD-sodium (MELD-Na), MELD 3.0, MELD-lactate, MELD-glomerular filtration rate assessment in patients with liver disease-sodium (MELD-GRAIL-Na), and MELD-plus. Association of MELD schemes with 30-day, 6-week, and 90-day mortality was assessed using DeLong test, and the predictive capacity of MELD systems was evaluated by comparing area under receiver operating characteristic (AUROC) curves. RESULTS: TIPS were created for ascites (n = 263, 47%), variceal hemorrhage (n = 247, 45%), or other indications (n = 43, 8%). All MELD systems statistically associated with mortality at each time point (P < .001). Based on 30-day, 6-week, and 90-day AUROC curves, none of the updated MELD systems showed superior predictive capacity for early mortality compared with original MELD-MELD: 0.847, 0.841, and 0.818; MELD-Na : 0.847, 0.846, and 0.829; MELD 3.0: 0.848, 0.850, and 0.842; MELD-lactate: 0.915, 0.881, and 0.866; MELD-GRAIL-Na: 0.851, 0.847, and 0.831; and MELD-Plus: 0.843-0.898, 0.853-0.910, and 0.814-0.829, respectively (P > .05). Findings were principally confirmed on subset analyses stratified by sex, TIPS indication, TIPS urgency, stent type, and TIPS date. CONCLUSIONS: Updated MELD systems have prognostic value for early mortality after TIPS creation. However, in this study, these newer schemes did not offer additional predictive power beyond the original MELD, which still effectively estimates early post-TIPS survival.

Source: Journal of Vascular and Interventional Radiology

DOI: 10.1016/j.jvir.2025.03.023

Authors: Taryi Wint, Wali Badar, Shrinidhi S. Kadkol, Ron C. Gaba

Institution: University of Illinois Chicago

Language: English

Topic: Liver Disease and Transplantation

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,600