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, Grace Knuttinen, Natasha M. Walzer, Eric R. Kallwitz, Jamie L. Berkes, Scott J. Cotler

Research output: Contribution to journalArticle

30 Citations (Scopus)

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
Number of pages10
JournalJournal of Vascular and Interventional Radiology
Volume24
Issue number3
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

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Transjugular Intrahepatic Portasystemic Shunt
End Stage Liver Disease
Liver Diseases
Mortality
Bilirubin
APACHE
ROC Curve
Multivariate Analysis
Hydrothorax
Portal Vein
Ascites
Medical Records
Thrombosis
Retrospective Studies
Sodium
Hemorrhage

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation. / Gaba, Ron C.; Couture, Patrick M.; Bui, James T.; Knuttinen, Grace; Walzer, Natasha M.; Kallwitz, Eric R.; Berkes, Jamie L.; Cotler, Scott J.

In: Journal of Vascular and Interventional Radiology, Vol. 24, No. 3, 01.03.2013, p. 411-420.

Research output: Contribution to journalArticle

Gaba, Ron C. ; Couture, Patrick M. ; Bui, James T. ; Knuttinen, Grace ; Walzer, Natasha M. ; Kallwitz, Eric R. ; Berkes, Jamie L. ; Cotler, Scott J. / Prognostic capability of different liver disease scoring systems for prediction of early mortality after transjugular intrahepatic portosystemic shunt creation. In: Journal of Vascular and Interventional Radiology. 2013 ; Vol. 24, No. 3. pp. 411-420.
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AU - Couture, Patrick M.

AU - Bui, James T.

AU - Knuttinen, Grace

AU - Walzer, Natasha M.

AU - Kallwitz, Eric R.

AU - Berkes, Jamie L.

AU - Cotler, Scott J.

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N2 - 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.

AB - 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.

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KW - Model for End-Stage Liver Disease

KW - Model for End-Stage Liver Disease sodium

KW - PI

KW - prognostic index

KW - TIPS

KW - transjugular intrahepatic portosystemic shunt

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