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MELD 3.0 Score for Predicting Survival in Patients with Cirrhosis After Transjugular Intrahepatic Portosystemic Shunt Creation

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Abstract

Background and aims

The selection of appropriate candidates for transjugular intrahepatic portosystemic shunt (TIPS) is important and challenging. To validate the Model for End-Stage Liver Disease (MELD) 3.0 in predicting mortality in patients with cirrhosis after TIPS creation.

Methods

A total of 855 consecutive patients with cirrhosis from December 2011 to October 2019 who underwent TIPS placement were retrospectively reviewed. The prognostic value of the MELD 3.0, MELD, MELD-Na, Child–Pugh and FIPS score was assessed using Harrell’s C concordance index (c-index). The Hosmer–Lemeshow test was used to test the goodness of fit of all models and the calibration plot was drawn.

Results

The c-index of the MELD 3.0 in predicting 3-month mortality was 0.727 (0.645–0.808), which were significantly superior to the MELD (0.663 [0.565–0.761]; P = 0.015), MELD-Na (0.672 [0.577–0.768]; P = 0.008) and FIPS (0.582 [0.477–0.687]; P = 0.015). The Child–Pugh score reached c-indices of 0.754 (0.673–0.835), 0.720 (0.649–0.792), 0.705 (0.643–0.766) and 0.665 (0.614–0.716) for 3-month, 6-month, 1-year, and 2-year mortality, respectively, which seems comparable to MELD 3.0. A MELD 3.0 of 14 could be used as a cut-off point for discriminating between high- and low-risk patients. The MELD 3.0 could stratify patients with Child–Pugh grade B (log-rank P < 0.001). The Child–Pugh score could stratify patients defined as low risk by MELD 3.0 (log-rank P < 0.001).

Conclusions

The MELD 3.0 was significantly superior to the MELD, MELD-Na and FIPS scores in predicting mortality in patients with cirrhosis after TIPS creation.

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Funding

This study was funded by the 1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH055) and the Project for Science & Technology Department of Sichuan Province(2020YFH0089).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China

    Jinlei Song, Xiaoze Wang, Yuling Yan, Tong Xiang & Xuefeng Luo

  2. Department of Gastroenterology, The Third Hospital of Mianyang, 190 Jiannan Road, Mianyang, 612000, Sichuan, China

    Jinlei Song

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  1. Jinlei Song
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Contributions

This study was designed by XL. Material preparation, data collection and analysis were performed by JS, XW, YY and TX. The first draft of the manuscript was written by JS. All authors read and approved the final manuscript.

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Correspondence to Xuefeng Luo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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10620_2023_7834_MOESM1_ESM.tif

The MELD 3.0 score stratifies patients with Child-Pugh grade B (A). The Child-Pugh score stratifies patients with MELD 3.0 score≤14 (B). Supplementary file1 (TIF 474 kb)

Supplementary file2 (DOCX 33 kb)

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Song, J., Wang, X., Yan, Y. et al. MELD 3.0 Score for Predicting Survival in Patients with Cirrhosis After Transjugular Intrahepatic Portosystemic Shunt Creation. Dig Dis Sci 68, 3185–3192 (2023). https://doi.org/10.1007/s10620-023-07834-3

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  • DOI: https://doi.org/10.1007/s10620-023-07834-3

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