Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score.
OBJECTIVE
To evaluate the ability of a model of end-stage liver disease (MELD) score to predict survival in a diverse group of patients who underwent elective transjugular intrahepatic portosystemic shunt (TIPS) creation in two tertiary care institutions.


METHODS
Patients who underwent elective TIPS creation in two institutions between May 1, 1999, and June 1, 2002, were selected. Patients who underwent emergency TIPS creation were excluded. One hundred sixty-six patients met the inclusion criteria. The MELD score was computed and compared with the survival rate. Survival curves were estimated with Kaplan-Meier product limit estimates and were compared with the log-rank test. Accuracy of the model was evaluated with the c statistic.


RESULTS
The survival rate for all patients was 88.4% at 30 days, 78.1% at 3 months, and 71.8% at 6 months. Significantly lower survival rates were found in patients with MELD scores of 18 or more in comparison to those with MELD scores of 17 or less (P =.001). The c statistic for prediction of 3-month survival on the basis of the MELD score was 0.76. The early (30-day) death rate for this series was 11.4%. There was a significant difference in the 30-day mortality rate between patients with MELD scores of 17 or less and those with scores of 18 or more (P =.001). Patients who underwent TIPS creation for the management of refractory ascites had a significantly lower survival rate in comparison to that for the management of variceal bleeding (P =.001).


CONCLUSIONS
Results confirm that after elective TIPS creation, patients with a MELD score of 18 or more have a significantly lower 3-month survival rate than do those with a MELD score of 17 or less.
Dept of Radiology, Div of Cardiovascular and Special Interventions, University of Texas Health Science Center at San Antonio, USA. hferral@rushradiology.org
Hector
H
Ferral
Pablo
P
Gamboa
Darren W
DW
Postoak
Vanessa S
VS
Albernaz
Carmen R
CR
Young
Kermitt V
KV
Speeg
C Alex
CA
McMahan
D000328:Adult; D001201:Ascites / Q000401:mortality / Q000601:surgery; D017558:Elective Surgical Procedures; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome