Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation

Ron C. Gaba, Patrick M. Couture, James T. Bui, M. Grace Knuttinen, Natasha M. Walzer, Eric R. Kallwitz, Jamie L. Berkes, Scott J. Cotler

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Purpose: To compare the performance of various liver disease scoring systems in predicting early mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods: In this single-institution retrospective study, eight scoring systems were used to grade liver disease in 211 patients (male-to-female ratio = 131:80; mean age, 54 y) before TIPS creation from 1999-2011. Scoring systems included bilirubin level, Child-Pugh (CP) score, Model for End-Stage Liver Disease (MELD) and Model for End-Stage Liver Disease sodium (MELD-Na) score, Emory score, prognostic index (PI), Acute Physiology and Chronic Health Evaluation (APACHE) 2 score, and Bonn TIPS early mortality (BOTEM) score. Medical record review was used to identify 30-day and 90-day clinical outcomes. The relationship of scoring parameters with mortality outcomes was assessed with multivariate analysis, and the relative ability of systems to predict mortality after TIPS creation was evaluated by comparing area under receiver operating characteristic (AUROC) curves. Results: TIPS were successfully created for variceal hemorrhage (n = 121), ascites (n = 72), hepatic hydrothorax (n = 15), and portal vein thrombosis (n = 3). All scoring systems had a significant association with 30-day and 90-day mortality (P<.050 in each case) on multivariate analysis. Based on 30-day and 90-day AUROC, MELD (0.878, 0.816) and MELD-Na (0.863, 0.823) scores had the best capability to predict early mortality compared with bilirubin (0.786, 0.749), CP (0.822, 0.771), Emory (0.786, 0.681), PI (0.854, 0.760), APACHE 2 (0.836, 0.735), and BOTEM (0.798, 0.698), with statistical superiority over bilirubin, Emory, and BOTEM scores. Conclusions: Several liver disease scoring systems have prognostic value for early mortality after TIPS creation. MELD and MELD-Na scores most effectively predict survival after TIPS creation.

Original languageEnglish (US)
Pages (from-to)411-420.e4
JournalJournal of Vascular and Interventional Radiology
Volume24
Issue number3
DOIs
StatePublished - Mar 2013

Keywords

  • APACHE
  • AUROC
  • Acute Physiology and Chronic Health Evaluation
  • BOTEM
  • Bonn TIPS early mortality
  • CP
  • Child-Pugh
  • MELD
  • MELD-Na
  • Model for End-Stage Liver Disease
  • Model for End-Stage Liver Disease sodium
  • PI
  • TIPS
  • area under receiver operating characteristic
  • prognostic index
  • transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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