Transjugular intrahepatic porto-systemic shunt in patients with liver cirrhosis and model for end-stage liver disease ≥ 15. Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort. Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score. Child–Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, Terborg PC.
#MELD SCORE 20 PLUS#
Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites. Comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. Early use of TIPS in patients with cirrhosis and variceal bleeding. García-Pagán JC, Caca K, Bureau C, et al. Of note, patients who required emergent TIPS were not excluded from the current study unless they died within 48 h, further biasing the cohort toward a graver baseline prognosis. In the current study, 100% of the TIPS cohort had decompensated cirrhosis, but the percentage in the non-TIPS cohort was not reported and was probably lower, again suggesting that the pre-intervention prognosis for the TIPS patients may have been inferior to that of the non-TIPS cohort. demonstrated that patients with any complications of cirrhosis, including those other than variceal bleeding such as encephalopathy and ascites, had significantly higher 1-year mortality rates than those with compensated cirrhosis even when matched by MELD scores. If the TIPS cohort had a higher percentage of patients who had experienced gastrointestinal bleeding, the prognosis for that cohort would be expected to be inferior at baseline. described, patients who experience gastrointestinal bleeding with or without ascites have a substantially poorer prognosis, with a 57% mortality rate/year, as compared to a 20% mortality rate/year for patients with ascites without variceal bleeding. It is likely that a greater percentage of the TIPS cohort had a history of gastrointestinal bleeding, since bleeding was the cause of death in 25 TIPS patients versus eight non-TIPS patients. It is unclear whether any or all of the non-TIPS patients experienced similar complications. By definition, all patients undergoing TIPS have experienced a complication of end-stage liver disease (ESLD), since the indications for TIPS are in fact such complications including variceal bleeding and refractory ascites. Nonetheless, this matching algorithm does not take into account other factors that may affect baseline prognosis. The authors matched the patients according to age and MELD score, two excellent predictors of survival outcome in cirrhosis. Another potential issue in this study is, as the authors acknowledge, selection bias between the TIPS and non-TIPS cohorts (Table 1). Although it is unclear how many of the patients in each cohort underwent OLT, the second most common reason not to pursue TIPS in the non-TIPS cohort was ineligibility for liver transplantation, since TIPS is a recognized tool to bridge patients to transplantation. In the current study, by treating OLT and death as the same outcome, the authors imply that OLT is a negative outcome, when in fact it is likely to improve patient survival. had noted in their study, censoring on the day of OLT avoids the influence of deaths due to surgical mortality and also avoids the influence of OLT in prolonging survival, since survival in patients who undergo OLT is significantly improved compared with those who do not undergo OLT. Because OLT and death have been combined as a single outcome, it is difficult to determine the actual mortality risk of TIPS from the data presented.