Prognostic Performance of Model for End-Stage Liver Disease (MELD) 3.0 for Transjugular Intrahepatic Portosystemic Shunt (TIPS) Creation.

Abstract

Purpose: To compare the prognostic performance of the model for end-stage liver disease (MELD) 3.0 in elective transjugular intrahepatic portosystemic shunt (TIPS) patients relative to MELD, MELD-Na, Freiburg index of post-TIPS survival, modified TIPS score, Child-Pugh, albumin-bilirubin, and chronic liver failure-consortium acute decompensation scores.

Materials and methods: A total of 342 patients (mean age: 55.5 years; 183 men) with portal hypertensive complications due to cirrhosis who underwent elective TIPS between December 2004 and June 2023 were reviewed. The prognostic performance of each scoring system for mortality at 30 days, 90 days, 1 year, and 3 years was evaluated using receiver operating characteristic curves to determine the area under the curve (AUC). Optimal cutoff values were determined accordingly. AUCs were compared using a bootstrap approach with 2000 resamples. Multivariable regression analyses were performed to identify independent risk factors.

Results: MELD 3.0 showed the highest AUC across the follow-up period. Compared to MELD and MELD-Na, MELD 3.0 showed significantly higher AUCs at 30 days (0.71, 0.71, and 0.82), 90 days (0.67, 0.68, and 0.77), 1 year (0.65, 0.69, and 0.77), and 3 years (0.63, 0.64, and 0.71) with corresponding P values of 0.049/0.022, 0.007/0.006, < 0.001/0.002, and 0.003/0.008, respectively. Regression analyses suggested MELD 3.0 as an independent risk factor for mortality, with a cutoff value of ≥ 19 for 30 day mortality (P < 0.001) and ≥ 17 for 90 day, 1 year, and 3 year mortality (P < 0.001).

Conclusion: MELD 3.0 may serve as a reliable prognostic tool compared to other existing scoring systems, acutely and in the longer term for elective TIPS creation.

Level of evidence: Level 3, Retrospective single-center cohort study.