MELD or Sodium MELD: A Comparison of the Ability of Two Scoring Systems to Predict Outcomes After Transjugular Intrahepatic Portosystemic Shunt Placement.

Abstract

<b>OBJECTIVE.</b> The purpose of this study was to compare the ability of the model for end-stage liver disease (MELD) and sodium MELD (MELD-Na) scoring systems to predict outcomes after transjugular intrahepatic portosystemic shunt (TIPS) placement. <b>MATERIALS AND METHODS.</b> Two hundred and nineteen consecutive patients who underwent TIPS placement were retrospectively reviewed. The primary outcomes were death within 30 days and 90 days after TIPS placement (30- and 90-day mortality, respectively), and secondary outcomes included death within 365 days after TIPS placement (365-day mortality), length of hospital stay, and readmission to the hospital within 30 days of TIPS placement. <b>RESULTS.</b> Mortality rates within 30, 90, and 365 days after TIPS placement were 2.3% (5/219), 8.2% (17/207), and 21.7% (41/189), respectively. Logistic regression showed that the MELD score predicted 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.00-1.27; <i>p</i> = 0.04) and trended toward predicting 90-day mortality (OR, 1.09; 95% CI, 1.00-1.18; <i>p</i> = 0.06), whereas the MELD-Na score did not predict 30-day mortality (OR, 1.02; 95% CI, 0.97-1.06; <i>p</i> = 0.51) or 90-day mortality (OR, 1.01; 95% CI, 0.98-1.15; <i>p</i> = 0.44). In a comparison of the ROC AUCs for MELD and MELD-Na, MELD showed improved prediction of 30-day mortality (<i>p</i> = 0.06) but did not significantly vary in prediction of 90- and 365-day mortality (<i>p</i> = 0.80 and <i>p</i> = 0.76, respectively). When the maximal inflection point for MELD and MELD-Na was analyzed on the basis of 90-day mortality, a score of 23 was found to be most significant for both MELD (OR, 6.6; 95% CI, 1.5-29.1; <i>p</i> = 0.01) and MELD-Na (OR, 3.3; 95% CI, 1.1-9.6; <i>p</i> = 0.03). MELD and MELD-Na both accurately predicted the length of hospital stay after TIPS placement (<i>p</i> = 0.005 and <i>p</i> = 0.01, respectively). <b>CONCLUSION.</b> MELD is superior to MELD-Na for predicting 30-day and, perhaps, 90-day mortality after TIPS placement. At present, decisions regarding patient selection for TIPS placement should be made on the basis of the MELD score rather than the MELD-Na score.