Comparison of Different Indices of Liver Disease Severity in Predicting Outcomes Following Transjugular Intrahepatic...

Careful patient selection is crucial to prevent liver failure due to hepatic blood flow shunting after transjugular intrahepatic portosystemic shunt (TIPS). This study compares the predictive abilities of Model for End-Stage Liver Disease-Sodium (MELD-Na), Model for End-Stage Liver Disease (MELD) 3.0, and Child-Pugh scores in TIPS patients with refractory ascites or variceal hemorrhage, focusing on mortality, ascites control, rebleeding, hepatic encephalopathy (HE), and sarcopenia's role in post-TIPS mortality.

A retrospective review was conducted on patients undergoing TIPS at the Institute of Liver and Biliary Sciences from 2013 to 2021. Exclusion criteria included incomplete data, inadequate follow-up, prior liver transplantation, or portal hypertension-related surgeries. After exclusions, 198 patients were analyzed. Pre-procedural and post-procedural data from medical records were used to calculate MELD-Na, MELD 3.0, and Child-Pugh scores. Outcomes, including 90-day and 30-day mortality, ascites control, rebleeding, HE at 1 and 3 months, and sarcopenia's association with 90-day mortality, were assessed over 5 years.

Overall 90-day mortality was 15.7% (31/198). MELD 3.0 showed slightly higher predictive accuracy than MELD-Na and Child-Pugh scores. For 30-day mortality (8%, 16/198), MELD 3.0 demonstrated statistical superiority over MELD-Na and Child-Pugh scores. Secondary outcomes over 5 years indicated MELD-Na and MELD 3.0 scores were more discriminative for short- to medium-term ascites control and rebleeding. HE incidence rose from 11% (1 month) to 14% (3 months), with Child-Pugh score as the strongest predictor. Sarcopenia significantly elevated 90-day mortality risk, with 26% mortality in sarcopenic versus 13% in non-sarcopenic patients.

MELD 3.0 offers a slight, non-significant improvement in 90-day mortality prediction over MELD-Na (P > 0.05) but significantly outperforms both in 30-day mortality (P = 0.05 vs. MELD-Na, P = 0.04 vs. Child-Pugh). MELD-Na and MELD 3.0 scores excel in predicting short- to medium-term outcomes, while Child-Pugh score predicts HE, and sarcopenia is a key mortality risk factor. A multi-faceted risk assessment is recommended to optimize TIPS patient management.