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SIR 2025

Portal Hypertension

Scientific Session

Session: Portal Hypertension 2

CLIF-C AD and MELD 3.0 Provide Better Prognostic Value in Emergency TIPS than MELD and MELD-Na: Single-Site Retrospective Analysis

Monday, March 31, 2025
3:27 PM – 3:36 PM CT
Location: Music City Center, 204
Purpose: To evaluate the mortality prognostic performances of the Model for End-Stage Liver Disease (MELD), MELD-Na, MELD 3.0, and Chronic Liver Failure-Consortium Acute Decompensation (CLIF-C AD) scoring systems in patients with cirrhosis who underwent emergent transjugular intrahepatic portosystemic shunt (TIPS) creation. 

Materials and Methods: From September 2005 to November 2023, 109 patients underwent emergent TIPS creation (mean age 49.6±12.9 years; 69 male [63%]), where emergent TIPS is defined as: (i) TIPS created within 24 hours after insufficient endoscopic intervention, or (ii) first-line TIPS creation in those presenting with shock. The MELD, MELD-Na, MELD 3.0, and CLIF-C AD scores before the procedure were evaluated as predictors of 30 day, 3 month, 1 year, and 2 year mortality after TIPS creation using receiver operating curves (ROC) to examine the area under the curve (AUC). DeLong's Paired-Sample test was used to compare ROCs and multivariate regression was used to compare the scoring systems and presented as odds ratio (OR). SPSS (IBM, Version 29.0.2.0) was used for all statistical analyses and 0.05. 

Results: For emergent TIPS cases, CLIF-C AD demonstrated highest prognostic value for mortality across the follow up period (30 day, AUC 0.880, 95% confidence interval [CI] 0.797-0.963; 3 month, AUC 0.859, 95% CI 0.772-0.946; 1 year, AUC 0.769, 95% CI 0.671-0.867; 2 year, AUC 0.780, 95% CI 0.686-0.874) though this was not significantly different than MELD 3.0 (P ≥ 0.115). At 30 day and 3 month follow up prognostic models were largely non-inferior except CLIF-C AD outperformed MELD-Na at 3 months (P = 0.045). At 1 year follow up, CLIF-CAD outperformed MELD (P = 0.048) while MELD 3.0 outperformed MELD and MELD-Na (P = 0.014 and 0.04 respectively). CLIF-C AD was more prognostic for mortality at 2 year follow up when compared to MELD and MELD-Na (P = 0.013 and 0.031 respectively) while MELD 3.0 outperformed MELD (P = 0.014). On multivariate analysis CLIF-C AD score accounted for the greatest odds of death at 30 day, 3 month, and 1 year (P ≤ 0.003), while MELD 3.0 also accounted for an increase risk in mortality at 1 year (P = 0.01).  

Conclusion: All four models performed well as prognostic indicators for survival at 30 days and 3 months after emergent TIPS creation. At a longer follow up of 1 year and 2 year CLIF-C AD and MELD 3.0 began to outperform MELD and MELD-Na. Finally, on multivariate analysis high CLIF-C AD had the highest odds of mortality. This project further expands our understanding of emergent TIPS prognosis when using these models.