Beyond MELD Score: Association of Machine Learning-derived CT Body Composition with 90-Day Mortality Post Transjugular Intrahepatic Portosystemic Shunt Placement.
Tarig Elhakim, Arian Mansur, Jordan Kondo, Omar Moustafa Fathy Omar, Khalid Ahmed, Azadeh Tabari, Allison Brea, Gabriel Ndakwah, Shams Iqbal, Andrew S Allegretti, Florian J Fintelmann, Eric Wehrenberg-Klee, Christopher Bridge, Dania Daye
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引用次数: 0
Abstract
Purpose: To determine the association of machine learning-derived CT body composition and 90-day mortality after transjugular intrahepatic portosystemic shunt (TIPS) and to assess its predictive performance as a complement to Model for End-Stage Liver Disease (MELD) score for mortality risk prediction.
Materials and methods: This retrospective multi-center cohort study included patients who underwent TIPS from 1995 to 2018 and had a contrast-enhanced CT abdomen within 9 months prior to TIPS and at least 90 days of post-procedural clinical follow-up. A machine learning algorithm extracted CT body composition metrics at L3 vertebral level including skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle density (SMD), subcutaneous fat area (SFA), subcutaneous fat index (SFI), visceral fat area (VFA), visceral fat index (VFI), and visceral-to-subcutaneous fat ratio (VSR). Independent t-tests, logistic regression models, and ROC curve analysis were utilized to assess the association of those metrics in predicting 90-day mortality.
Results: A total of 122 patients (58 ± 11.8, 68% male) were included. Patients who died within 90 days of TIPS had significantly higher MELD (18.9 vs. 11.9, p < 0.001) and lower SMA (123 vs. 144.5, p = 0.002), SMI (43.7 vs. 50.5, p = 0.03), SFA (122.4 vs. 190.8, p = 0.009), SFI (44.2 vs. 66.7, p = 0.04), VFA (105.5 vs. 171.2, p = 0.003), and VFI (35.7 vs. 57.5, p = 0.02) compared to those who survived past 90 days. There were no significant associations between 90-day mortality and BMI (26 vs. 27.1, p = 0.63), SMD (30.1 vs. 31.7, p = 0.44), or VSR (0.97 vs. 1.03, p = 0.66). Multivariable logistic regression showed that SMA (OR = 0.97, p < 0.01), SMI (OR = 0.94, p = 0.03), SFA (OR = 0.99, p = 0.01), and VFA (OR = 0.99, p = 0.02) remained significant predictors of 90-day mortality when adjusted for MELD score. ROC curve analysis demonstrated that including SMA, SFA, and VFA improves the predictive power of MELD score in predicting 90-day mortality after TIPS (AUC, 0.84; 95% CI: 0.77, 0.91; p = 0.02).
Conclusion: CT body composition is positively predictive of 90-day mortality after TIPS and improves the predictive performance of MELD score.
Level of evidence: Level 3, Retrospective multi-center cohort study.
期刊介绍：
CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.
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