title: Predictive accuracy comparison of MELD and Child-Turcotte-Pugh scores for survival in patients underwent TIPS placement: a systematic meta-analytic review.
abstract: BACKGROUND
  Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores have been used commonly to predict the survival in the patients with liver diseases underwent transjugular intrahepatic portosystemic shunt (TIPS). However, a debate has continued for years whether CTP could be replaced by MELD score. We performed a systematic meta-analytic review to compare the prediction capability of both scores in survival among patients with TIPS.
  
  
  METHODS
  Retrospective cohort studies among patients with TIPS were published as of May 2013 were identified by systematically searching four electronic literature database, such as Ovid Medline, PubMed, EMBASE, and ISI Web of Science. The difference of standardized mean difference (SMD) of c-statistics for the predictive accuracy of 1-, 3-, 6-, and 12-month survival for both MELD and CP scores, defined as effect size (ES), was calculated for each individual study and then pooled across studies using standard meta-analyses with a random effects model. Publication bias was evaluated using funnel plots and Kendall's rank correlation tests.
  
  
  RESULTS
  174 researches articles or conference abstracts were searched and reviewed using the combination of relevant terms in the articles. Finally, 11 articles were defined as eligible studies to evaluate simultaneously the predictive accuracy of MELD and CTP scores. In the meta-analyses, MELD score was superior to CP score in predicting 3-month survival after TIPS (mean ES, 0.63; 95% confidence interval [CI], 0.13-1.14; P=0.01), but the predictive capability in 1-month, 6-month, and 12-month survival was not significant (1-month: mean ES, 0.79; 95% CI, -0.24-1.83; P=0.13; 6-month: mean ES, 0.46; 95% CI, -2.46-3.37; P=0.76; 12-month: mean ES, 0.36; 95% CI, -0.25-0.96; P=0.25).
  
  
  CONCLUSIONS
  No enough evidence are confirmed so far that MELD score is better than CTP score to assess the overall prognosis after TIPS, especially long-term predictions, but 3-month predictive capability of MELD score significantly outperform CTP score.
authors.affiliation: Department of Interventional Radiology, The Anhui Provincial Hospital No. 7 Lujiang Avenue, Hefei 230000, Anhui, China.
authors.forename: Chunze
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Interventional Radiology, The Anhui Provincial Hospital No. 7 Lujiang Avenue, Hefei 230000, Anhui, China.
authors.forename: Changlong
authors.initials: C
authors.lastname: Hou
authors.affiliation: Department of Interventional Radiology, The Anhui Provincial Hospital No. 7 Lujiang Avenue, Hefei 230000, Anhui, China.
authors.forename: Delei
authors.initials: D
authors.lastname: Cheng
authors.affiliation: Department of Interventional Radiology, The Anhui Provincial Hospital No. 7 Lujiang Avenue, Hefei 230000, Anhui, China.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Tang
authors.affiliation: Department of Interventional Radiology, The Anhui Provincial Hospital No. 7 Lujiang Avenue, Hefei 230000, Anhui, China.
authors.forename: Weifu
authors.initials: W
authors.lastname: Lv
keywords: Child-Turcotte-Pugh (CTP) score; Transjugular intrahepatic portosystemic shunt (TIPS); meta-analysis; systematic review; the model for end-stage liver disease (MELD) score