Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
Department of Gastroenterology, The Third Hospital of Mianyang, 190 Jiannan Road, Mianyang, 612000, Sichuan, China.
Dig Dis Sci. 2023 Jul;68(7):3185-3192. doi: 10.1007/s10620-023-07834-3. Epub 2023 Jan 30.
The selection of appropriate candidates for transjugular intrahepatic portosystemic shunt (TIPS) is important and challenging. To validate the Model for End-Stage Liver Disease (MELD) 3.0 in predicting mortality in patients with cirrhosis after TIPS creation.
A total of 855 consecutive patients with cirrhosis from December 2011 to October 2019 who underwent TIPS placement were retrospectively reviewed. The prognostic value of the MELD 3.0, MELD, MELD-Na, Child-Pugh and FIPS score was assessed using Harrell's C concordance index (c-index). The Hosmer-Lemeshow test was used to test the goodness of fit of all models and the calibration plot was drawn.
The c-index of the MELD 3.0 in predicting 3-month mortality was 0.727 (0.645-0.808), which were significantly superior to the MELD (0.663 [0.565-0.761]; P = 0.015), MELD-Na (0.672 [0.577-0.768]; P = 0.008) and FIPS (0.582 [0.477-0.687]; P = 0.015). The Child-Pugh score reached c-indices of 0.754 (0.673-0.835), 0.720 (0.649-0.792), 0.705 (0.643-0.766) and 0.665 (0.614-0.716) for 3-month, 6-month, 1-year, and 2-year mortality, respectively, which seems comparable to MELD 3.0. A MELD 3.0 of 14 could be used as a cut-off point for discriminating between high- and low-risk patients. The MELD 3.0 could stratify patients with Child-Pugh grade B (log-rank P < 0.001). The Child-Pugh score could stratify patients defined as low risk by MELD 3.0 (log-rank P < 0.001).
The MELD 3.0 was significantly superior to the MELD, MELD-Na and FIPS scores in predicting mortality in patients with cirrhosis after TIPS creation.
经颈静脉肝内门体分流术（TIPS）的合适患者选择很重要，也具有挑战性。本研究旨在验证终末期肝病模型（MELD）3.0 预测 TIPS 术后肝硬化患者死亡率的能力。
回顾性分析 2011 年 12 月至 2019 年 10 月期间接受 TIPS 治疗的 855 例连续肝硬化患者的临床资料。采用 Harrell's C 一致性指数（c-index）评估 MELD 3.0、MELD、MELD-Na、Child-Pugh 和 FIPS 评分预测 TIPS 术后 3 个月死亡率的预后价值。采用 Hosmer-Lemeshow 检验评估所有模型的拟合优度，并绘制校准图。
MELD 3.0 预测 3 个月死亡率的 c-index 为 0.727（0.645-0.808），显著优于 MELD（0.663 [0.565-0.761]；P=0.015）、MELD-Na（0.672 [0.577-0.768]；P=0.008）和 FIPS（0.582 [0.477-0.687]；P=0.015）。Child-Pugh 评分预测 3 个月、6 个月、1 年和 2 年死亡率的 c-index 分别为 0.754（0.673-0.835）、0.720（0.649-0.792）、0.705（0.643-0.766）和 0.665（0.614-0.716），与 MELD 3.0 相似。14 分的 MELD 3.0 可作为区分高危和低危患者的截断值。MELD 3.0 可对 Child-Pugh 分级 B 的患者进行分层（log-rank P<0.001）。Child-Pugh 评分可对 MELD 3.0 定义的低危患者进行分层（log-rank P<0.001）。
MELD 3.0 显著优于 MELD、MELD-Na 和 FIPS 评分，可预测 TIPS 术后肝硬化患者的死亡率。
