Comparative Prognostic Utility of Updated Model for End-Stage Liver Disease Scores for Prediction of Early Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation

Sunday, March 30, 2025

3:36 PM – 3:45 PM CT

Location: Music City Center, 202 A

Presenting Author(s)

TW

Taryi Wint, MBBS (she/her/hers)

Research Associate
University of Illinois at Chicago, United States

Author/Co-author(s)

Wali Badar, MD

Resident physician
University of Illinois at Chicago, United States
RG

Ron C. Gaba, MD, MS

Professor
University of Illinois at Chicago, United States

Purpose: The Model for End-Stage Liver Disease (MELD) score is an established, objective, and robust predictor of mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. However, purported shortcomings—such as omission of electrolyte abnormalities, renal function, and biological sex in score calculation—have led to the development of updated MELD scoring systems, some of which have been adopted for liver transplant allocation. Yet, the relative value of these new MELD systems for predicting survival after TIPS is unclear. Therefore, this study compared the performance of the updated MELD systems to the legacy MELD score for predicting early mortality after TIPS.

Materials and Methods: In this single center retrospective study, 6 MELD score variations were used to quantify liver function in 553 patients (M:F=332:221, mean age 55 years) who underwent TIPS between 1998-2023. Scoring systems included legacy MELD, MELD sodium (MELD-Na), MELD 3.0, MELD-lactate, MELD-glomerular filtration rate assessment in patients with liver disease-sodium (MELD-GRAIL-Na), and MELD-Plus. 30-day, 6-week, and 90-day survival outcomes were documented. The association of MELD schemes with mortality outcomes was assessed using DeLong’s test, and the relative performance of the MELD systems for predicting post-TIPS mortality was evaluated by comparing area under receiver operating characteristic (AUROC) curves.

Results: TIPS were created for ascites (n=260, 47%), variceal hemorrhage (n=250, 45%), or other indications (n=43, 8%). All MELD systems had statistically significant association with mortality at each time point (P< 0.05). Based on 30-day, 6-week, and 90-day AUROC, none of the updated MELD systems showed superior predictive capacity for early mortality compared to legacy MELD: MELD (0.854, 0.759, 0.707), MELD-Na (0.852, 0.796, 0.737), MELD 3.0 (0.855, 0.815, 0.779), MELD-lactate (0.909, 0.479, 0.750), MELD-GRAIL-Na (0.858, 0.780, 0.745), and MELD-Plus (0.914, insufficient data, insufficient data). Findings were principally confirmed on subset analyses stratified by sex (men vs. women), TIPS indication (bleeding vs. non-bleeding), TIPS urgency (elective vs. emergent), stent type (bare metal vs. stent-graft), and TIPS date (pre-2010 vs. post-2010).

Conclusion: Updated MELD scoring systems have prognostic value for early mortality after TIPS. However, in this study, these newer schemes did not offer additional predictive power beyond legacy MELD, which still effectively estimates early post-TIPS survival.