MELD score as a predictor of early death in patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) procedures.
OBJECTIVE
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.


CONCLUSIONS
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.
Montgomery
Aaron
A
Section of Cardiovascular and Special interventions, Department of Radiology, The University of Texas Health Sciences Center at San Antonio, Mail code 7880, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
Ferral
Hector
H
Vasan
Rajiv
R
Postoak
Darren W
DW
D000367:Age Factors; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D003404:Creatinine / Q000097:blood; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000209:etiology; D017093:Liver Failure / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D017082:Portal Pressure / Q000502:physiology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D003404:Creatinine; D001663:Bilirubin