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Erschienen in:
30.01.2023 | Original Article
MELD 3.0 Score for Predicting Survival in Patients with Cirrhosis After Transjugular Intrahepatic Portosystemic Shunt Creation
Erschienen in: Digestive Diseases and Sciences | Ausgabe 7/2023
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Background and aims
The selection of appropriate candidates for transjugular intrahepatic portosystemic shunt (TIPS) is important and challenging. To validate the Model for End-Stage Liver Disease (MELD) 3.0 in predicting mortality in patients with cirrhosis after TIPS creation.
Methods
A total of 855 consecutive patients with cirrhosis from December 2011 to October 2019 who underwent TIPS placement were retrospectively reviewed. The prognostic value of the MELD 3.0, MELD, MELD-Na, Child–Pugh and FIPS score was assessed using Harrell’s C concordance index (c-index). The Hosmer–Lemeshow test was used to test the goodness of fit of all models and the calibration plot was drawn.
Results
The c-index of the MELD 3.0 in predicting 3-month mortality was 0.727 (0.645–0.808), which were significantly superior to the MELD (0.663 [0.565–0.761]; P = 0.015), MELD-Na (0.672 [0.577–0.768]; P = 0.008) and FIPS (0.582 [0.477–0.687]; P = 0.015). The Child–Pugh score reached c-indices of 0.754 (0.673–0.835), 0.720 (0.649–0.792), 0.705 (0.643–0.766) and 0.665 (0.614–0.716) for 3-month, 6-month, 1-year, and 2-year mortality, respectively, which seems comparable to MELD 3.0. A MELD 3.0 of 14 could be used as a cut-off point for discriminating between high- and low-risk patients. The MELD 3.0 could stratify patients with Child–Pugh grade B (log-rank P < 0.001). The Child–Pugh score could stratify patients defined as low risk by MELD 3.0 (log-rank P < 0.001).
Conclusions
The MELD 3.0 was significantly superior to the MELD, MELD-Na and FIPS scores in predicting mortality in patients with cirrhosis after TIPS creation.