Abstract
The Model for End-Stage Liver Disease (MELD) score was originally developed to assess prognosis after TIPS placement. The addition of sodium to the MELD score (MELD-Na) has been proposed as a more accurate prognostic score for overall survival. We assessed the performance of MELD vs. MELD-Na score in predicting 90-day survival after TIPS placement. Retrospective review of TIPS placements for ascites and hemorrhage at a major academic healthcare network between 1994 and 2014. MELD/MELD-Na scores were assessed for their ability to predict 90-day survival using area under the receiver operative curves (AuROC) and compared using change in AuROC, category free net reclassification index (NRI), and integrated discrimination improvement (IDI). Stratified analysis by TIPS indication was performed. Three hundred seventy seven TIPS placements were analyzed (225 for hemorrhage, 152 for ascites/hydrothorax). 90-day survival was 75% (282/377) for all subjects, 76% (170/225) for the hemorrhage subgroup, and 74% (112/150) for the ascites subgroup. For all subjects, median MELD score was 16 [IQR 11, 21] with AuROC of 0.77. Median MELD-Na was 19 [IQR 14, 23] with AuROC of 0.77. MELD and MELD-Na were highly correlated (r = 0.94; p < 0.001). MELD AuROC was 0.82 for the bleeding subgroup and 0.70 for the ascites subgroup. Addition of Na to the MELD score did not improve its performance by change in AuROC, NRI, or IDI for all patients or when stratified by TIPS indication, except for NRI in the bleeding subgroup (see Table). MELD and MELD-Na performed similarly when predicting 90-day survival after TIPS. MELD-Na score performs better in TIPS placed for hemorrhage compared to TIPS placed for ascites. Further study is required to improve predictive scores in this population.Tabled 1All TIPSn = 377Hemorrhagen = 225Ascitesn = 152MELDMELD-NaP ValueMELDMELD-NaP-valueMELDMELD-NaP ValueAuROC0.770.770.620.820.830.510.700.700.26Category-free NRI0.050.680.330.050.210.26IDI0.00040.530.010.20-0.000020.98 Open table in a new tab
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