SIR 2024
Portal Hypertension
Kenkichi Michimoto, MD, PhD (he/him/his)
Research Fellow
Dotter Department of Interventional Radiology
Financial relationships: Full list of relationships is listed on the CME information page.
Leonardo Campos, MD
Interventional Radiologist
Oregon Health & Science University
Disclosure information not submitted.
Norah Languyen, None
Researcher
Dotter Department of Interventional Radiology
Disclosure information not submitted.
Kristey Nguyen, B.S
Medical Student
Oregon Health & Science University
Disclosure information not submitted.
James Palmer, MD
Interventional Radiology Resident
Oregon Health and Science University
Disclosure information not submitted.
Brandon Tran, BS, None
Researcher
Dotter Department of Interventional Radiology
Disclosure information not submitted.
Omar Hamam, MD
Research Fellow
Beth Israel Deaconess Medical Center - Harvard Medical School
Disclosure information not submitted.
Khashayar Farsad, MD, PhD (he/him/his)
Professor
Oregon Health and Science University
Disclosure information not submitted.
A total of 358 patients (aged 25-80 years; mean, 55.0 years) with cirrhosis who underwent TIPS creation at a single institution from September 2005 to May 2022 were retrospectively reviewed. Inclusion criteria were cirrhosis and portal hypertensive complications, available lab work within 45 days of TIPS, and available follow up data for mortality. Patients without cirrhosis were excluded. The MELD, MELD-Na, MELD 3.0, and Child–Pugh scores were evaluated as predictors of 30-day, 3-month, and 1-year mortality after TIPS using receiver operating curves (ROC) to examine the area under the curve (AUC).
Results: Of the four grading systems, MELD 3.0 demonstrated the greatest sensitivity and specificity for predicting survival at all three time points: 30-day (cutoff ≥19; AUC 0.77, 95% confidence interval [CI] 0.682-0.857), 3-month (cutoff ≥18; AUC 0.755, 95% CI 0.683-0.827), and 1-year (cutoff ≥18; AUC 0.716, 95% CI 0.651-0.781). These results were significantly superior to those of the MELD (cutoffs for 30-day, 3-months, and 1-year mortality: ≥16, ≥16, and ≥15 respectively; AUCs: 0.685, P=0.018; 0.687, P=0.018; and 0.645, P=0.003), MELD-Na (cutoffs: ≥19, ≥16, and ≥19 respectively; AUCs: 0.689, P=0.013; 0.688, P=0.008; and 0.658, P=0.006), and Child-Pugh scores (AUCs for 30-day and 3-months mortality: 0.644, P=0.006 and 0.644, P=0.02 respectively).
Conclusion:
The new MELD 3.0 score demonstrated greater sensitivity and specificity for predicting mortality after TIPS compared to MELD, MELD-Na, and Child-Pugh scoring systems, representing a more clinically relevant scoring system for patient selection.