title: New model for end stage liver disease improves prognostic capability after transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  Cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites or recurrent variceal bleeding are at risk for decompensation and death. This study examined whether a new model for end stage liver disease (MELD), which incorporates serum sodium (MELDNa), is a better predictor of death or transplant after TIPS than the original MELD.
  
  
  METHODS
  One hundred forty-eight consecutive patients undergoing nonemergent TIPS for refractory ascites or recurrent variceal bleeding from 1997 to 2006 at a single center were evaluated retrospectively. Cox model analysis was performed with death or transplant within 6 months as the end point. The models were compared using the Harrell's C index. Recursive partitioning determined the optimal MELDNa cutoff to maximize the risk:benefit ratio of TIPS.
  
  
  RESULTS
  The predictive ability of MELDNa was superior to MELD, particularly in patients with low MELD scores. The C indices (95% confidence interval [CI]) for MELDNa and MELD were 0.65 (95% CI, 0.55-0.71) and 0.58 (95% CI, 0.51-0.67) using a cut-off score of 18, and 0.72 (95% CI, 0.60-0.85) and 0.62 (95% CI, 0.49-0.74) using a cut-off score of 15. Using a MELDNa >15, 22% of patients were reclassified to a higher risk with an event rate of 44% compared with 10% when the score was <or=15.
  
  
  CONCLUSIONS
  MELDNa performed better than MELD in predicting death or transplant after non-emergent TIPS, especially in patients with low MELD scores. A MELD score <or=18 can provide a false positive prognosis; a MELDNa score <or=15 provides a more accurate risk prediction.
authors: Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA. jennifer.guy@ucsf.edu
authors: Jennifer
authors: J
authors: Guy
authors: Ma
authors: M
authors: Somsouk
authors: Stephen
authors: S
authors: Shiboski
authors: Robert
authors: R
authors: Kerlan
authors: John M
authors: JM
authors: Inadomi
authors: Scott W
authors: SW
authors: Biggins
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011170:Portasystemic Shunt, Surgical; D011379:Prognosis; D012189:Retrospective Studies; D044967:Serum / Q000737:chemistry; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D012964:Sodium