title: Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation.
abstract: OBJECTIVE
  To compare the performance of various liver disease scoring systems in predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation.
  
  
  METHODS
  In this single-institution retrospective study, eight scoring systems were used to grade liver disease in 211 patients (male-to-female ratio = 131:80; mean age, 54 y) before TIPS creation from 1999-2011. Scoring systems included bilirubin level, Child-Pugh (CP) score, Model for End-Stage Liver Disease (MELD) and Model for End-Stage Liver Disease sodium (MELD-Na) score, Emory score, prognostic index (PI), Acute Physiology and Chronic Health Evaluation (APACHE) 2 score, and Bonn TIPS early mortality (BOTEM) score. Medical record review was used to identify 30-day and 90-day clinical outcomes. The relationship of scoring parameters with mortality outcomes was assessed with multivariate analysis, and the relative ability of systems to predict mortality after TIPS creation was evaluated by comparing area under receiver operating characteristic (AUROC) curves.
  
  
  RESULTS
  TIPS were successfully created for variceal hemorrhage (n = 121), ascites (n = 72), hepatic hydrothorax (n = 15), and portal vein thrombosis (n = 3). All scoring systems had a significant association with 30-day and 90-day mortality (P<.050 in each case) on multivariate analysis. Based on 30-day and 90-day AUROC, MELD (0.878, 0.816) and MELD-Na (0.863, 0.823) scores had the best capability to predict early mortality compared with bilirubin (0.786, 0.749), CP (0.822, 0.771), Emory (0.786, 0.681), PI (0.854, 0.760), APACHE 2 (0.836, 0.735), and BOTEM (0.798, 0.698), with statistical superiority over bilirubin, Emory, and BOTEM scores.
  
  
  CONCLUSIONS
  Several liver disease scoring systems have prognostic value for early mortality after TIPS creation. MELD and MELD-Na scores most effectively predict survival after TIPS creation.
authors: Department of Radiology, University of Illinois Medical Center at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA. rgaba@uic.edu
authors: Ron C
authors: RC
authors: Gaba
authors: Patrick M
authors: PM
authors: Couture
authors: James T
authors: JT
authors: Bui
authors: M Grace
authors: MG
authors: Knuttinen
authors: Natasha M
authors: NM
authors: Walzer
authors: Eric R
authors: ER
authors: Kallwitz
authors: Jamie L
authors: JL
authors: Berkes
authors: Scott J
authors: SJ
authors: Cotler
mesh_terms: D018806:APACHE; D000328:Adult; D019540:Area Under Curve; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002641:Chicago; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001663:Bilirubin