title: Within-patient temporal variance in MELD score and impact on survival prediction after TIPS creation.
abstract: BACKGROUND
  To assess within-patient temporal variability in Model for End Stage Liver Disease (MELD) scores and impact on outcome prognostication after transjugular intrahepatic portosystemic shunt (TIPS) creation.
  
  
  METHODS
  In this single institution retrospective study, MELD score was calculated in 68 patients (M:F = 42:26, mean age 55 years) at 4 pre-procedure time points (1, 2-6, 7-14, and 15-35 days) before TIPS creation. Medical record review was used to identify 30- and 90-day clinical outcomes. Within-patient variability in pre-procedure MELD scores was assessed using repeated measures analysis of variance, and the ability of MELD scores at different time points to predict post-TIPS mortality was evaluated by comparing area under receiver operating characteristic (AUROC) curves.
  
  
  RESULTS
  TIPS were successfully created for ascites (n = 30), variceal hemorrhage (n = 29), hepatic hydrothorax (n = 8), and portal vein thrombosis (n = 1). Pre-TIPS MELD scores showed significant (P = 0.032) within-subject variance that approached ± 18.5%. Higher MELD scores demonstrated greater variability in sequential scores as compared to lower MELD scores. Overall 30- and 90-day patient mortality was 22% (15/67) and 38% (24/64). AUROC curves showed that most recent MELD scores performed on the day of TIPS had superior predictive capacity for 30- (0.876, P = 0.037) and 90-day (0.805 P = 0.020) mortality compared to MELD scores performed 2-6 or 7-14 days prior.
  
  
  CONCLUSIONS
  In conclusion, MELD scores show within-patient variability over time, and scores calculated on the day of TIPS most accurately predict risk and should be used for patient selection and counseling.
authors.affiliation: Department of Radiology, Section of Interventional Radiology.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.forename: Kruti D
authors.initials: KD
authors.lastname: Shah
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Couture
authors.forename: Ahmad
authors.initials: A
authors.lastname: Parvinian
authors.forename: Jeet
authors.initials: J
authors.lastname: Minocha
authors.forename: M Grace
authors.initials: MG
authors.lastname: Knuttinen
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
mesh_terms: D000704:Analysis of Variance; D019540:Area Under Curve; D002641:Chicago; D003661:Decision Support Techniques; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome