Michimoto Kenkichi, Campos Leonardo, Cushen Spencer, Suzuki Takeshi, Yamada Kentaro, Naugler Willscott, Farsad Khashayar
Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239-3011, USA.
Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3485 S Bond Ave, Portland, OR, 97239, USA.
Cardiovasc Intervent Radiol. 2025 Jul 14. doi: 10.1007/s00270-025-04116-5.
To compare the prognostic performance of the model for end-stage liver disease (MELD) 3.0 in elective transjugular intrahepatic portosystemic shunt (TIPS) patients relative to MELD, MELD-Na, Freiburg index of post-TIPS survival, modified TIPS score, Child-Pugh, albumin-bilirubin, and chronic liver failure-consortium acute decompensation scores.
A total of 342 patients (mean age: 55.5 years; 183 men) with portal hypertensive complications due to cirrhosis who underwent elective TIPS between December 2004 and June 2023 were reviewed. The prognostic performance of each scoring system for mortality at 30 days, 90 days, 1 year, and 3 years was evaluated using receiver operating characteristic curves to determine the area under the curve (AUC). Optimal cutoff values were determined accordingly. AUCs were compared using a bootstrap approach with 2000 resamples. Multivariable regression analyses were performed to identify independent risk factors.
MELD 3.0 showed the highest AUC across the follow-up period. Compared to MELD and MELD-Na, MELD 3.0 showed significantly higher AUCs at 30 days (0.71, 0.71, and 0.82), 90 days (0.67, 0.68, and 0.77), 1 year (0.65, 0.69, and 0.77), and 3 years (0.63, 0.64, and 0.71) with corresponding P values of 0.049/0.022, 0.007/0.006, < 0.001/0.002, and 0.003/0.008, respectively. Regression analyses suggested MELD 3.0 as an independent risk factor for mortality, with a cutoff value of ≥ 19 for 30 day mortality (P < 0.001) and ≥ 17 for 90 day, 1 year, and 3 year mortality (P < 0.001).
MELD 3.0 may serve as a reliable prognostic tool compared to other existing scoring systems, acutely and in the longer term for elective TIPS creation.
Level 3, Retrospective single-center cohort study.
比较终末期肝病模型（MELD）3.0在择期经颈静脉肝内门体分流术（TIPS）患者中的预后评估性能，与MELD、MELD-Na、TIPS术后生存的弗莱堡指数、改良TIPS评分、Child-Pugh评分、白蛋白-胆红素评分以及慢性肝衰竭联盟急性失代偿评分进行比较。
回顾性分析2004年12月至2023年6月期间因肝硬化导致门静脉高压并发症而接受择期TIPS的342例患者（平均年龄：55.5岁；男性183例）。使用受试者工作特征曲线评估各评分系统在30天、90天、1年和3年时的死亡预后性能，以确定曲线下面积（AUC）。相应地确定最佳截断值。采用2000次重采样的自助法比较AUC。进行多变量回归分析以确定独立危险因素。
在整个随访期间，MELD 3.0显示出最高的AUC。与MELD和MELD-Na相比，MELD 3.0在30天（0.71、0.71和0.82）、90天（0.67、0.68和0.77）、1年（0.65、0.69和0.77）和3年（0.63、0.64和0.71）时的AUC显著更高，相应的P值分别为0.049/0.022、0.007/0.006、<0.001/0.002和0.003/0.008。回归分析表明MELD 3.0是死亡的独立危险因素，30天死亡率的截断值≥19（P<0.001），90天、1年和3年死亡率的截断值≥17（P<0.001）。
与其他现有评分系统相比，MELD 3.0可能是一种可靠的预后工具，无论是在急性期还是长期用于择期TIPS手术。
3级，回顾性单中心队列研究。
