Wint Taryi, Badar Wali, Kadkol Shrinidhi S, Gaba Ron C
Department of Radiology, University of Illinois at Chicago, Chicago, Illinois.
Department of Radiology, University of Illinois at Chicago, Chicago, Illinois. Electronic address: https://twitter.com/walsterIR.
J Vasc Interv Radiol. 2025 Jul;36(7):1125-1132.e6. doi: 10.1016/j.jvir.2025.03.023. Epub 2025 Apr 8.
To compare the performance of updated model for end-stage liver disease (MELD) systems with that of the original MELD score for predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation.
In this single-center retrospective study, 6 MELD variations were quantified in 553 patients (n = 332; 60% male; mean age, 55 years) who underwent TIPS creation between 1998 and 2023. Scoring systems included original MELD, MELD-sodium (MELD-Na), MELD 3.0, MELD-lactate, MELD-glomerular filtration rate assessment in patients with liver disease-sodium (MELD-GRAIL-Na), and MELD-plus. Association of MELD schemes with 30-day, 6-week, and 90-day mortality was assessed using DeLong test, and the predictive capacity of MELD systems was evaluated by comparing area under receiver operating characteristic (AUROC) curves.
TIPS were created for ascites (n = 263, 47%), variceal hemorrhage (n = 247, 45%), or other indications (n = 43, 8%). All MELD systems statistically associated with mortality at each time point (P < .001). Based on 30-day, 6-week, and 90-day AUROC curves, none of the updated MELD systems showed superior predictive capacity for early mortality compared with original MELD-MELD: 0.847, 0.841, and 0.818; MELD-Na : 0.847, 0.846, and 0.829; MELD 3.0: 0.848, 0.850, and 0.842; MELD-lactate: 0.915, 0.881, and 0.866; MELD-GRAIL-Na: 0.851, 0.847, and 0.831; and MELD-Plus: 0.843-0.898, 0.853-0.910, and 0.814-0.829, respectively (P > .05). Findings were principally confirmed on subset analyses stratified by sex, TIPS indication, TIPS urgency, stent type, and TIPS date.
Updated MELD systems have prognostic value for early mortality after TIPS creation. However, in this study, these newer schemes did not offer additional predictive power beyond the original MELD, which still effectively estimates early post-TIPS survival.
比较终末期肝病模型（MELD）系统更新版与原始MELD评分在预测经颈静脉肝内门体分流术（TIPS）术后早期死亡率方面的表现。
在这项单中心回顾性研究中，对1998年至2023年间接受TIPS手术的553例患者（n = 332；60%为男性；平均年龄55岁）的6种MELD变体进行了量化。评分系统包括原始MELD、MELD-钠（MELD-Na）、MELD 3.0、MELD-乳酸、肝病患者肾小球滤过率评估-钠（MELD-GRAIL-Na）和MELD-plus。使用德龙检验评估MELD方案与30天、6周和90天死亡率的相关性，并通过比较受试者操作特征曲线下面积（AUROC）评估MELD系统的预测能力。
TIPS手术的实施是为了治疗腹水（n = 263，47%）、静脉曲张出血（n = 247，45%）或其他适应症（n = 43，8%）。所有MELD系统在每个时间点与死亡率均存在统计学关联（P < .001）。基于30天、6周和90天的AUROC曲线，与原始MELD相比，更新后的MELD系统在早期死亡率预测能力上均未显示出优势——MELD：0.847、0.841和0.818；MELD-Na：0.847、0.846和0.829；MELD 3.0：0.848、0.850和0.842；MELD-乳酸：0.915、0.881和0.
