Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score

Abstract

Purpose: To evaluate the ability of a model of end-stage liver disease (MELD) score to predict survival in a diverse group of patients who underwent elective transjugular intrahepatic portosystemic shunt (TIPS) creation in two tertiary care institutions.

Materials and methods: Patients who underwent elective TIPS creation in two institutions between May 1, 1999, and June 1, 2002, were selected. Patients who underwent emergency TIPS creation were excluded. One hundred sixty-six patients met the inclusion criteria. The MELD score was computed and compared with the survival rate. Survival curves were estimated with Kaplan-Meier product limit estimates and were compared with the log-rank test. Accuracy of the model was evaluated with the c statistic.

Results: The survival rate for all patients was 88.4% at 30 days, 78.1% at 3 months, and 71.8% at 6 months. Significantly lower survival rates were found in patients with MELD scores of 18 or more in comparison to those with MELD scores of 17 or less (P =.001). The c statistic for prediction of 3-month survival on the basis of the MELD score was 0.76. The early (30-day) death rate for this series was 11.4%. There was a significant difference in the 30-day mortality rate between patients with MELD scores of 17 or less and those with scores of 18 or more (P =.001). Patients who underwent TIPS creation for the management of refractory ascites had a significantly lower survival rate in comparison to that for the management of variceal bleeding (P =.001).

Conclusion: Results confirm that after elective TIPS creation, patients with a MELD score of 18 or more have a significantly lower 3-month survival rate than do those with a MELD score of 17 or less.