Comparing MELD, MELD-Na, and MELD 3.0 as Predictors of Survival and Hepatic Encephalopathy After Primary TIPS Placement

Monday, March 31, 2025

3:36 PM – 3:45 PM CT

Location: Music City Center, 204

Presenting Author(s)

Ashley Lamba

Medical Student
Zucker School of Medicine at Hofstra/Northwell, United States

Author/Co-author(s)

EH

Eusha R. Hasan

Medical Student
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States
IR

Ian Rumball, MD

Resident
Medical College of Wisconsin, United States
ED

Ethan Davoudzadeh, MD

IR Fellow
Memorial Sloan Kettering, United States
NT

Nayan Tiwary, MD

Radiology Resident
Atlantic Health Morristown Medical Center, United States
AG

Alexa Giammarino, MD

Resident
Northwell Health, United States
SS

Sanjaya Satapathy, MD, MBBS

Medical Director of Liver Transplantation
Northwell Health, United States
CG

Craig Greben, MD/MBA

Interventional Radiology Attending
Northwell Health, United States
JW

Jonathan Weinstein, MD

Interventional Radiologist
Northwell Health, United States

Purpose: The Model for End-Stage Liver Disease (MELD) scoring systems are essential tools for determining the suitability of patients for trans-jugular intrahepatic portosystemic shunt (TIPS) procedures by estimating survival outcomes. These scores reflect the severity of liver disease through components indicative of hepatic biosynthetic failure, metabolic dysfunction, and hepatorenal syndrome. This study aims to assess the predictive accuracy of the MELD, MELD-Na, and MELD 3.0 scores, including their individual subcomponents, in forecasting both survival and the development of hepatic encephalopathy (HE) after primary TIPS placement.

Materials and Methods: This multicenter retrospective study analyzed 128 patients who underwent primary TIPS placement for chronic liver disease between November 2018 and April 2024. Patient demographics, TIPS indications, underlying liver disease etiology, and relevant laboratory parameters were collected. The study focused on three mortality risk predictors—MELD, MELD-Na, and MELD 3.0—and their subcomponents. Kaplan-Meier survival analysis and log-rank tests, both unstratified and stratified, were utilized to evaluate predictors of survival duration and HE development.

Results: Baseline total bilirubin (p < 0.0001), INR (p = 0.0003), and albumin (p = 0.0068) were significant predictors of reduced survival post-TIPS, while creatinine (p = 0.0675) and sodium (p = 0.3773) were not. On multivariate analysis, only total bilirubin significantly predicted survival (p = 0.0028). MELD, MELD-Na, and MELD 3.0 all predicted survival (p < 0.0001 for each), with MELD 3.0 showing the highest predictive accuracy (AUC: 0.73, 95% CI: 0.60-0.86), followed by MELD-Na and MELD. A notable difference was observed in overall survival probabilities among patients stratified only by baseline total bilirubin and INR, but not by creatinine, albumin, or sodium. All MELD scoring systems were poor predictors of HE development within 90 days post-TIPS (MELD - AUC: 0.57, 95% CI: 0.47-0.68; MELD Na - AUC: 0.56, 95% CI: 0.46-0.66; MELD 3.0 - AUC: 0.59, 95% CI: 0.49-0.69).

Conclusion: Total bilirubin was the sole independent predictor of post-TIPS survival on multivariate analysis. MELD 3.0 demonstrated superior accuracy in predicting survival compared to MELD-Na and traditional MELD, but none of the scoring systems effectively predicted HE after TIPS, indicating the need for further research to develop more comprehensive models.