Comparative Analysis of MELD, MELD-Na and MELD 3.0 Scores in Predicting Mortality Following Elective TIPS.

To compare the original Model of End-Stage Liver Disease (MELD) score with its subsequent iterations to determine which model most accurately predicts short- and intermediate-term mortality following elective transjugular intrahepatic portosystemic shunt (TIPS) placement.

Materials and Methods:

A single center retrospective review was performed on patients undergoing TIPS from 2018 through 2022.  A total of 108 patients were identified, of which 102 patients met inclusion criteria.  Demographics, preprocedural laboratory values and patient outcomes were recorded. Primary outcomes included mortality at 30-days, 90-days and 1-year following TIPS.

Results:

Mortality rates following elective TIPS were 8.8% (9/102) at 30-days, 14.7% (15/102) at 90-days and 20.6% (21/102) at 1-year. There were significantly higher MELD 3.0 scores versus MELD when comparing patient groups based on mortality at 90-days (17.2 [± 4.5] vs 14.2 [±3.4], p=0.05) and 1-year (16.6 [± 4.5] vs 13.9 [± 3.6], p=0.045). No significant differences were found when comparing to MELD-Na scores. In patients with advanced liver dysfunction (scores of 20 or greater) who experienced mortality within 90 days, MELD 3.0 (33.3% [4/12]) and MELD-Na (33.3% [3/9]) scores provided more accurate mortality prediction in comparison to the original MELD score (16.7% [1/6]).

Conclusion:

In summary, MELD 3.0 outperformed the original MELD score in predicting 90-days and 1-year mortality following elective TIPS, confirming that factors such as nutritional status, a lower creatinine cutoff and gender outcome disparities improve mortality prediction in the setting of liver dysfunction.