Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting

Abstract

OBJECTIVES:Recently, new prognostic models (Model for End-Stage Liver Disease [MELD model] and Emory score) were proposed for the prediction of survival in transjugular intrahepatic portosystemic shunt (TIPS) patients. Although the MELD model is considered to be superior and has consecutively been applied to priority listing for liver transplantation, these models have never been directly compared in terms of long-term prognosis. We therefore compared the prognostic accuracy of the different models, including the Child-Pugh score, in an unselected cohort of TIPS patients followed long-term. METHODS:Baseline risk scores for 162 unselected consecutive TIPS patients followed until death (n ϭ 81), liver transplantation, or end of observation (n ϭ 81) (mean follow-up 30.7 Ϯ 26.4 months) were calculated, and respective concordance-(c-)statistics for the predictive accuracy of 3-, 12-, and 36-month survival for the three models were compared statistically. RESULTS:

Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease

“…The CTP score performed relatively well compared with the MELD score in all categories and was an independent predictor of 1-year mortality even after adjusting for the MELD score. Other authors have recently reported that both the MELD and CTP scores are fairly equivalent for predicting intermediate and short-term mortality in patients with cirrhosis [19] and in patients with advanced liver disease undergoing TIPS [20,21] although one study did show a superior discrimination power of MELD compared to CTP scores for predicting early mortality after TIPS [22]. The independent predictive ability of the CTP score may be because unlike the MELD score it accounts for hepatic encephalopathy.…”

Elevated Soluble Tumor Necrosis Factor Receptor 75 Concentrations Identify Patients With Liver Cirrhosis at Risk of Death

“…This is supported by the majority of studies that show an inferiority of the CTP score in comparison with MELD. [23][24][25][26][27] However, some authors question these findings and show that CTP might be at least equally predictive compared with MELD. 23,28 -30 In addition, we demonstrated that sTNF-R 75 serum levels and MELD were significantly more accurate than the sTNF-R 75/55 ratio in predicting short-term survival at 6 months ( Figure 4).…”

Value of renal resistive index in hepatitis C virus related liver cirrhosis and its response to midodrine

“…In predicting the outcomes of patients with cirrhosis, the Model for End-Stage Liver Disease (MELD) has been shown to be superior to the traditional Child-Pugh classification and other systems of risk stratification (5,6). Several studies have shown that hyponatremia is a strong predictor of early mortality, independent of MELD score (7).…”