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CardioVascular and Interventional Radiology

, Volume 28, Issue 3, pp 307–312 | Cite as

MELD Score as a Predictor of Early Death in Patients Undergoing Elective Transjugular Intrahepatic Portosystemic Shunt (TIPS) Procedures

  • Aaron Montgomery
  • Hector FerralEmail author
  • Rajiv Vasan
  • Darren W. Postoak
Clinical Investigation

Abstract

Purpose

To Evaluate the MELD score as a predictor of 30-day mortality in patients undergoing elective TIPS procedures.

Methods

This was a retrospective, IRB-approved study. The medical records of all patients who underwent a TIPS procedure between May 1, 1999 and June 1, 2003 in a single institution were reviewed. Patients who underwent elective TIPS were selected. Elective TIPS was performed in 119 patients with a mean age of 55.1 (± 9.6) years. The MELD and Child-Pugh scores before TIPS, etiology of cirrhosis, portosystemic gradients before and after TIPS, procedure time, and procedural complications were obtained from the medical records. The MELD and Child-Pugh scores before TIPS were compared between the survivor group (SG) and the early death (EDG) group. The early death rate was calculated for MELD score subgroups (1–10, 11–17, 18–24, and >24). Data were analyzed using the Fisher exact test, chi-square test and independent-sample t-test. A p value of less than 0.05 was considered significant.

Results

Technical success rate was 100%. The early death rate was 10.9% (13/119). The mean MELD scores before TIPS were 19.4 (± 5.9) (EDG) and 14 (± 4.2) (SG) (p = 0.025). The early death rate was highest in the pre-TIPS MELD > 24 subgroup. The Child-Pugh scores were 9.0 (± 1.6) (SG) and 9.8 ± 1.06 (EDG) (p = 0.08). The mean portosystemic gradients before TIPS were 20.5 (± 7.7) mmHg (EDG) and 22.7 (± 7.3) (SG) (p > 1) and the mean portosystemic gradients after TIPS were 6.5 (± 3.5) (EDG) and 6.9 (± 2.4) (SG) (p > 1). The mean procedural times were 95.6 (± 8.4) min (EDG) and 89.2 (± 7.5) min (SG) (p > 1). No early death was attributed to a fatal complication during TIPS.

Conclusion

The MELD score is useful in identifying patients at a higher risk of early death after an elective TIPS. On th basis of our results, we do not endorse elective TIPS in patients with MELD scores > 24.

Keywords

Child-Pugh score MELD score TIPS 

References

  1. 1.
    Rossle, M, Siegerstetter, V, Huber, M, Ochs, A 1998The first decade of the transjugular intrahepatic portosystemic shunt (TIPS): State of the artLiver187389PubMedGoogle Scholar
  2. 2.
    Richter, GM, Noeldge, G, Palmaz, JC,  et al. 1990Transjugular intrahepatic portacaval stent shunt: Preliminary clinical resultsRadiology17410271030Google Scholar
  3. 3.
    Sanyal, AJ, Genning, C, Reddy, KR,  et al. 2003The North American Study for the Treatment of Refractory AscitesGastroenterology124634641CrossRefPubMedGoogle Scholar
  4. 4.
    Spencer, EB, Cohen, DT, Darcy, MD 2002Safety and efficacy of transjugular intrahepatic portosystemic shunt creation for the treatment of hepatic hydrothoraxJ Vasc Interv Radiol13385390PubMedGoogle Scholar
  5. 5.
    Bilbao, JI, Quiroga, J, Herrero, JI, Benito, A 2002Transjugular intrahepatic portosystemic shunt (TIPS): current status and future possibilitiesCardiovasc Intervent Radiol25251269CrossRefPubMedGoogle Scholar
  6. 6.
    Patch, D, Nikolopoulou, V, McCormick, A,  et al. 1998Factors related to early mortality after transjugular intrahepatic portosystemic shunt for failed endoscopic therapy in acute variceal bleedingJ Hepatol28454460CrossRefPubMedGoogle Scholar
  7. 7.
    Rubin, RA, Haskal, ZJ, O’Brien, CB, Cope, C, Brass, CA 1995Transjugular intrahepatic portosystemic shunting: Decreased survival for patients with high APACHE II scoresAm J Gastroenterol90556563PubMedGoogle Scholar
  8. 8.
    Brensing, KA, Raab, P, Textor, J,  et al. 2002Prospective evaluation of a clinical score for 60-day mortality after transjugular intrahepatic portosystemic stent-shunt: Bonn TIPSS early mortality analysisEur J Gastroenterol Hepatol14723731CrossRefPubMedGoogle Scholar
  9. 9.
    Malinchoc, M, Kamath, PS, Gordon, FD, Peine, CJ, Rank, J, ter Borg, PC 2000A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shuntsHepatology31864871CrossRefPubMedGoogle Scholar
  10. 10.
    Chalasani, N, Clark, WS, Martin, LG,  et al. 2000Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shuntingGastroenterology118138144PubMedGoogle Scholar
  11. 11.
    Schepke, M, Roth, F, Fimmers, R,  et al. 2003Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shuntingAm J Gastroenterol9811671174CrossRefPubMedGoogle Scholar
  12. 12.
    Forman, LM, Lucey, MR 2001Predicting the prognosis of chronic liver disease: An evolution from Child to MELD. Mayo End-stage Liver DiseaseHepatology33473475CrossRefPubMedGoogle Scholar
  13. 13.
    Angermayr, B, Cejna, M, Karnel, F,  et al. 2003Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shuntGut52879885CrossRefPubMedGoogle Scholar
  14. 14.
    Salerno, F, Merli, M, Cazzaniga, M,  et al. 2002MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shuntJ Hepatol36494500CrossRefPubMedGoogle Scholar
  15. 15.
    Rajan, DK, Haskal, ZJ, Clark, TW 2002Serum bilirubin and early mortality after transjugular intrahepatic portosystemic shunts: Results of a multivariate analysisJ Vasc Interv Radiol13155161PubMedGoogle Scholar
  16. 16.
    Encarnacion, CE, Palmaz, JC, Rivera, FJ,  et al. 1995Transjugular intrahepatic portosystemic shunt placement for variceal bleeding: Predictors of mortalityJ Vasc Interv Radiol6687694PubMedGoogle Scholar
  17. 17.
    Ferral, H, Gamboa, P, Postoak, DW,  et al. 2004Survival after elective transjugular intrahepatic portosystemic shunt creation: Prediction with model for end-stage liver disease scoreRadiology231231236Google Scholar
  18. 18.
    Rouillard, SS, Bass, NM, Roberts, JP,  et al. 1998Severe hyperbilirubinemia after creation of transjugular intrahepatic portosystemic shunts: Natural history and predictors of outcomeAnn Intern Med128374377PubMedGoogle Scholar
  19. 19.
    Walser, E, Ozkan, OS, Raza, S, Soloway, R, Gajula, L 2003Hepatic perfusion as a predictor of mortality after transjugular intrahepatic portosystemic shunt creation in patients with refractory ascitesJ Vasc Interv Radiol1412511257PubMedGoogle Scholar
  20. 20.
    Saxon, RR, Keller, FS 1997Technical aspects of accessing the portal vein during the TIPS procedureJ Vasc Interv Radiol8733744PubMedGoogle Scholar
  21. 21.
    Kamath, PS, Wiesner, RH, Malinchoc, M,  et al. 2001A model to predict survival in patients with end-stage liver diseaseHepatology33464470CrossRefPubMedGoogle Scholar
  22. 22.
    Encarnacion, CE, Palmaz, JC, Rivera, FJ,  et al. 1995Transjugular intrahepatic portosystemic shunt placement for variceal bleeding: Predictors of mortalityJ Vasc Intervent Radiol6687694Google Scholar
  23. 23.
    Angermayr, B, Cejna, M, Koenig, F,  et al. 2003Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE-covered stentgrafts versus bare stentsHepatology3810431050CrossRefPubMedGoogle Scholar
  24. 24.
    Deibert, P, Schwarz, S, Olschewski, M, Siegerstetter, V, Blum, HE, Rossle, M 1998Risk factors and prevention of early infection after implantation or revision of transjugular intrahepatic portosystemic shunts: Results of a randomized studyDig Dis Sci4317081713CrossRefPubMedGoogle Scholar
  25. 25.
    Trotter, JF, Suhocki, PV 1999Incarceration of umbilical hernia following transjugular intrahepatic portosystemic shunt for the treatment of ascitesLiver Transpl Surg5209210CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Aaron Montgomery
    • 1
  • Hector Ferral
    • 1
    • 2
    Email author
  • Rajiv Vasan
    • 1
  • Darren W. Postoak
    • 1
  1. 1.Section of Cardiovascular and Special interventions, Department of RadiologyThe University of Texas Health Sciences Center atSan AntonioSan AntonioUSA
  2. 2.Department of Radiology, Interventional RadiologyRush University Medical CenterChicagoUSA

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