8, 9 Hyponatremia has been established as a key predictor of mortality in patients with cirrhosis independent of the MELD score. 6, 7 However, previous studies have shown that subgroups of patients are at a higher risk of mortality than predicted by their MELD score, thus restricting their access to LT. The model for end-stage liver disease (MELD) score was first developed to predict early death of patients undergoing elective TIPS placement and was subsequently adopted for organ allocation in candidates for liver transplantation (LT) in 2002. 3 – 5 As a result, several prognostic scoring systems have been developed to assist in patient selection for TIPS placement in patients with cirrhosis. 1 – 3 Careful patient selection for TIPS is vital because the resultant shunting of hepatic blood flow leads to an increased risk of post-procedure hepatic encephalopathy, liver failure, and morbidity/mortality in patients with significantly impaired liver function. The transjugular intrahepatic portosystemic shunt (TIPS) is created using percutaneous endovascular techniques to treat complications of portal hypertension such as variceal hemorrhage, refractory ascites, and hepatic hydrothorax. ConclusionsĪlthough MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients, MELD tended to outperform MELD-Na to predict mortality after TIPS. There were 24 patients with high MELD-Na ≥17, but with low MELD <15, and 90-day mortality in this group was 8.3%. In a comparison of the areas under the ROCs for MELD and MELD-Na, MELD was superior to MELD-Na for 30-day (0.762 vs. Overall, mortality after TIPS was 15% at 30 days and 16.7% at 90 days. The mean pre-TIPS MELD and MELD-Na were 13 and 15, respectively. There were 186 eligible patients in the analysis. We performed receiver operating characteristic (ROC) curve analysis to assess the performance of MELD and MELD-Na. The primary outcome was mortality, and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS placement. We performed a retrospective chart review of patients who underwent TIPS placement between 20 at our institution. However, there are limited studies to compare the MELD with MELD-Na to predict mortality after TIPS. The MELD-sodium (MELD-Na) score has replaced MELD for organ allocation for liver transplantation. The model for end-stage liver disease (MELD) was originally developed to predict survival after transjugular intrahepatic portosystemic shunt (TIPS).
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