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Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic
B Angermayr1, M Cejna, F Karnel
1Department of Gastroenterology and Hepatology, University of Vienna Medical School, Austria.
Insights
The Model for End-Stage Liver Disease (MELD) score and Child-Pugh score (CPS) predict survival after transjugular intrahepatic portosystemic shunt (TIPS) procedures. Both scores demonstrated equal accuracy in predicting short-term survival, with renal function being a key predictor.
Area of Science:
- Hepatology
- Interventional Radiology
- Medical Statistics
Background:
- Prognostic scores are crucial for patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures.
- The established Child-Pugh score (CPS) has limitations, leading to the development of the Model for End-Stage Liver Disease (MELD) score.
Purpose of the Study:
- To compare the predictive power of CPS and MELD for patient survival post-TIPS.
- To validate the original MELD formula.
- To assess the predictive value of individual score determinants outside of a study setting.
Main Methods:
- Retrospective analysis of 501 patients undergoing elective TIPS placement between 1991 and 2001.
- Utilized Cox proportional hazards regression, log rank test, Kaplan-Meier analysis, and concordance c statistics.
- Included 475 patients who met inclusion criteria for analysis.
Main Results:
- Median follow-up was 5.2 years, with a median survival of 4.6 years.
- Independent predictors of mortality included creatinine, bilirubin, age, and refractory ascites.
- While MELD was a primary predictor in multivariate analysis, both MELD and CPS showed equal predictive accuracy for 1, 3, and 12-month survival via c statistics. Renal function emerged as the strongest independent predictor of survival.
Conclusions:
- Both MELD and CPS demonstrate comparable accuracy for predicting survival in patients undergoing TIPS.
- Renal function is a critical independent predictor of survival post-TIPS.
- There is no compelling reason to replace the established Child-Pugh score with MELD for prognosis assessment in TIPS patients based on this study.
Background:
In patients undergoing transjugular intrahepatic portosystemic shunt (TIPS), prognostic scores may identify those with a poor prognosis or even those with a clear survival benefit. The Child-Pugh score (CPS) is well established but several drawbacks have led to development of the model of end stage liver disease (MELD).
Aim:
The aim of the study was to compare the predictive power of CPS and MELD, to validate the original MELD formula, and to assess the predictive value of the determinants used in the two prognostic scores outside of a study setting.
Patients:
A total of 501 patients underwent elective TIPS placement and 475 patients fulfilled the inclusion criteria.
Methods:
Data of all patients undergoing elective TIPS in one university hospital and four community hospitals in Vienna, Austria, between 1991 and 2001, were analysed retrospectively. The main statistical tests were Cox proportional hazards regression model, the log rank test, Kaplan-Meier analysis, and concordance c statistics.
Results:
Median follow up was 5.2 years and median survival was 4.6 years. During follow up, 230 patients died, 75 within three months after TIPS placement. In stepwise proportional hazards analyses, independent predictors of death were creatinine level, bilirubin level, age, and refractory ascites. MELD was better in predicting survival in a stepwise Cox model but both scores were equally predictive in c statistics for one month, three month, and one year survival. Renal function was the strongest independent predictor of survival.
Conclusions:
Although MELD was the primary predictor of overall survival in multivariate analysis, c statistics showed that both scores can be used for patients undergoing TIPS with equal accuracy. For assessing prognosis in patients undergoing TIPS implantation, there seems little reason to replace the well established Child-Pugh score.
