Department of Radiology, Section of Interventional Radiology.
Ann Hepatol. 2013 Sep-Oct;12(5):797-802.
To assess within-patient temporal variability in Model for End Stage Liver Disease (MELD) scores and impact on outcome prognostication after transjugular intrahepatic portosystemic shunt (TIPS) creation.
In this single institution retrospective study, MELD score was calculated in 68 patients (M:F = 42:26, mean age 55 years) at 4 pre-procedure time points (1, 2-6, 7-14, and 15-35 days) before TIPS creation. Medical record review was used to identify 30- and 90-day clinical outcomes. Within-patient variability in pre-procedure MELD scores was assessed using repeated measures analysis of variance, and the ability of MELD scores at different time points to predict post-TIPS mortality was evaluated by comparing area under receiver operating characteristic (AUROC) curves.
TIPS were successfully created for ascites (n = 30), variceal hemorrhage (n = 29), hepatic hydrothorax (n = 8), and portal vein thrombosis (n = 1). Pre-TIPS MELD scores showed significant (P = 0.032) within-subject variance that approached ± 18.5%. Higher MELD scores demonstrated greater variability in sequential scores as compared to lower MELD scores. Overall 30- and 90-day patient mortality was 22% (15/67) and 38% (24/64). AUROC curves showed that most recent MELD scores performed on the day of TIPS had superior predictive capacity for 30- (0.876, P = 0.037) and 90-day (0.805 P = 0.020) mortality compared to MELD scores performed 2-6 or 7-14 days prior.
In conclusion, MELD scores show within-patient variability over time, and scores calculated on the day of TIPS most accurately predict risk and should be used for patient selection and counseling.
评估终末期肝病模型(MELD)评分在患者体内的时间变化及其对经颈静脉肝内门体分流术(TIPS)后预后的影响。
在这项单中心回顾性研究中,我们在 TIPS 术前的 4 个时间点(术前 1、2-6、7-14 和 15-35 天)计算了 68 例患者(M:F=42:26,平均年龄 55 岁)的 MELD 评分。通过病历回顾确定了 30 天和 90 天的临床结局。使用重复测量方差分析评估术前 MELD 评分的个体内变异性,并通过比较接受者操作特征(ROC)曲线下面积(AUROC)来评估不同时间点的 MELD 评分预测 TIPS 后死亡率的能力。
TIPS 成功用于治疗腹水(n=30)、静脉曲张出血(n=29)、肝性胸水(n=8)和门静脉血栓形成(n=1)。术前 MELD 评分显示出显著的(P=0.032)个体内方差,接近±18.5%。与低 MELD 评分相比,较高的 MELD 评分显示出更大的连续评分变异性。总体而言,30 天和 90 天患者死亡率分别为 22%(15/67)和 38%(24/64)。AUROC 曲线显示,TIPS 当天的最新 MELD 评分对 30 天(0.876,P=0.037)和 90 天(0.805,P=0.020)死亡率的预测能力优于术前 2-6 天或 7-14 天的 MELD 评分。
综上所述,MELD 评分在患者体内随时间变化,TIPS 当天计算的评分最准确地预测风险,应用于患者选择和咨询。