title: MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  Patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) are at risk of early death due to end-stage liver failure. The aim of this study was to compare model of end-stage liver disease (MELD) and Child-Pugh scores as predictors of survival after TIPS.
  
  
  METHODS
  We studied 140 cirrhotic patients treated with elective TIPS. Concordance (c)-statistic was used to assess the ability of MELD or Child-Pugh scores to predict 3-month survival. The prediction of overall survivals was estimated by comparing actuarial curves of subgroups of patients stratified according to either Child-Pugh scores or MELD risk scores.
  
  
  RESULTS
  During a median follow-up of 23.7 months, 55 patients died, 14 underwent liver transplantation and seven were lost to follow-up. For 3-month survival, the discrimination power of MELD score was superior to Child-Pugh score (0.84 vs. 0.70, z=2.07; P=0.038). Unlike Pugh score, MELD score identified two subgroups of Child C patients with different overall survivals (P=0.027). The comparison between observed and predicted survivals showed that MELD score overrates death risk.
  
  
  CONCLUSIONS
  MELD score is superior to Child-Pugh score as predictor of short-term outcome after TIPS. Its accuracy, however, decreases for long-term predictions.
authors.affiliation: Department of Internal Medicine, University of Milan, Via Pace 9, 20122 Milan, Italy. francesco.salerno@unimi.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.forename: Massimo
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: Valentina
authors.initials: V
authors.lastname: Valeriano
authors.forename: Plinio
authors.initials: P
authors.lastname: Rossi
authors.forename: Andrea
authors.initials: A
authors.lastname: Lovaria
authors.forename: Daniele
authors.initials: D
authors.lastname: Meregaglia
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lubatti
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000401:mortality*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome