A total of 255 patients underwent TIPS placement during the study period. This retrospective single-center study aimed to determine whether MELDNa was more accurate than MELD in predicting outcomes after TIPS placement.Īfter approval by an internal review board, a retrospective review of all patients who underwent TIPS placement between January 1, 2006, and December 31, 2016, at a high-volume, academic liver transplant center was performed. More data are required to better understand the superiority of one scoring system over the other for predicting outcomes for patients undergoing TIPS placement in the current era. Covered TIPS stents are now the standard of care because of superior stent patency and lower rates of hepatic encephalopathy. Previous studies comparing MELD-Na to MELD in terms of TIPS placement outcomes have reported differing conclusions and have been limited by the inclusion of patients who received bare metal stents. What is not clear, however, is whether MELD-Na is superior to MELD in predicting patient outcomes after TIPS placement. MELD-Na has been used for liver transplant allocation since 2015. After the emergence of data showing that the serum sodium level is an independent predictor of mortality among patients with cirrhosis who are on transplant wait-lists, the serum sodium level was incorporated into determination of the MELD score, resulting in the sodium MELD (MELD-Na) scoring system. MELD was later validated among patients with cirrhosis who did not undergo TIPS placement, and it was adopted by the liver transplant community in 2002 to ensure objective and equitable allocation of organs. The model for end-stage liver disease (MELD) score was first introduced in 2000 to predict 90-day survival among patients undergoing elective TIPS placement. As a result, several scoring systems have been evaluated to assist in patient selection for TIPS placement, particularly in the setting of elective surgery. Careful patient selection is important because shunting of hepatic blood flow from TIPS placement may result in liver failure in patients with significantly impaired liver function. The transjugular intrahepatic portosystemic shunt (TIPS) was developed and has been proven effective for treating complications of portal hypertension such as variceal bleeding and refractory ascites. Keywords: cirrhosis, model for end-stage liver disease, portal hypertension, sodium model for end-stage liver disease, transjugular intrahepatic portosystemic shunt At present, decisions regarding patient selection for TIPS placement should be made on the basis of the MELD score rather than the MELD-Na score. MELD is superior to MELD-Na for predicting 30-day and, perhaps, 90-day mortality after TIPS placement. MELD and MELD-Na both accurately predicted the length of hospital stay after TIPS placement ( p = 0.005 and p = 0.01, respectively).ĬONCLUSION. When the maximal inflection point for MELD and MELD-Na was analyzed on the basis of 90-day mortality, a score of 23 was found to be most significant for both MELD (OR, 6.6 95% CI, 1.5–29.1 p = 0.01) and MELD-Na (OR, 3.3 95% CI, 1.1–9.6 p = 0.03). In a comparison of the ROC AUCs for MELD and MELD-Na, MELD showed improved prediction of 30-day mortality ( p = 0.06) but did not significantly vary in prediction of 90- and 365-day mortality ( p = 0.80 and p = 0.76, respectively). The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement.
0 Comments
Leave a Reply. |