Evaluation of a Model to Predict Poor Survival in Patients Undergoing Elective TIPS Procedures

Ferral, Héctor; Vasan, Rajiv; Speeg, Kermit V; Serna, Samuel; Young, Carmen; Postoak, Darren; Wholey, Michael H.; McMahan, C. Alex

doi:10.1016/s1051-0443(07)61951-4

Cited by 38 publications

(40 citation statements)

References 21 publications

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“…Survival rates are similar when the indication is ascites (48%-76%). [25][26][27][28][29][30] In one series but not another, survival rates were significantly worse when the indication was refractory ascites compared with variceal bleeding. 26,29 These differences likely reflect variations in the severity of liver disease between the different studies.…”

Section: Mortalitymentioning

confidence: 88%

“…MELD and a number of other models have been developed to predict survival following TIPS. [25][26][27][28][29] The modified MELD model utilizes serum bilirubin level, international normalized ratio for prothrombin time, and serum creatinine level (cause of cirrhosis was also used previously but has since been abandoned). These three variables are used to create the following equation: [3.8 log e (bilirubin [g/dL]) ϩ 11.2 log e (international normalized ratio) ϩ 9.6 log e (creatinine [mg/dL].…”

Section: Mortalitymentioning

confidence: 99%

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The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

2005

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Section: Mortalitymentioning

confidence: 88%

Section: Mortalitymentioning

confidence: 99%

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

2005

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“…Previous series that utilized the MELD score have identified a score of 18 as a threshold for high-risk patients with a median survival duration Ͻ 90 days. 32,42 However, Angermaryr et al, 43 found that a MELD score Ͼ 18 was insufficient to rank patients into high-risk and low-risk groups. Using a population of 475 TIPS patients, those investigators determined that a MELD score Ͼ 14 was a statistically better threshold value.…”

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Wallace

Madoff

Ahrar

et al. 2004

Cancer

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BACKGROUNDTransjugular intrahepatic portosystemic shunt (TIPS) placement has emerged as an effective and minimally invasive method of treating portal hypertension and its associated complications. To the authors' knowledge there is limited documentation of its use for percutaneous shunting in patients with hepatic and extrahepatic malignancies. The current study reports the authors' experience with TIPS in the oncology setting.METHODSThirty‐eight patients with cancer underwent TIPS procedures. Nineteen patients had a history of hepatic malignancy. All medical records and imaging studies were reviewed retrospectively. The indication for TIPS, the presence of malignancy, procedural details, complications, survival, and treatment success were assessed.RESULTSPrimary technical success was accomplished in 37 of 38 patients (97%) without technical procedure‐related complications. Hepatic encephalopathy occurred in 15 of 34 patients (44%), with 3 patients requiring shunt reduction. Premature shunt occlusion (< 30 days) occurred in 3 patients (8%). Recurrent hemorrhage occurred in 1 of 19 patients (5%), and ascites and hepatic hydrothorax resolved or improved subjectively in 9 of 12 patients (75%). Shunts traversed malignancy in 9 patients, and varying degrees of portal compromise were encountered in 12 patients (32%). The overall 30‐day and 90‐day survival rates were 84% and 60%, respectively. There was a statistically significant difference in 90‐day survival rates for patients who had ascites and hepatic hydrothorax indications (27%) compared with patients who had variceal and portal gastropathy indications (84%; P = 0.0075). In addition, the 90‐day survival rate was significantly lower in patients who had primary hepatic malignancies (36%) compared with the remainder of the study population (74%; P = 0.0077), and it was significantly lower in patients who had model for end‐stage liver disease (MELD) scores ≥ 12 (P = 0.0020).CONCLUSIONSTIPS was performed safely for patients with cancer without increasing rates of procedure‐related complications. However, some patients subgroups, such at those with malignancy and ascites, primary hepatic malignancy, or MELD scores ≥ 12, had the lowest 90‐day survival rates. Cancer 2004. © 2004 American Cancer Society.

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“…For instance, if a patient with a MELD score of 28 and refractory ascites is in a UNOS region where organs are available to patients whose MELD score is 28-30, continued conservative measures rather than TIPS might be recommended. In general, a MELD score of Ͼ24 is associated with an increased risk of 3-month post TIPS mortality, 52,53 and consequently, TIPS should be avoided in such patients unless they are candidates for liver transplantation.…”

Section: Meld In the Management Of Patients With Esldmentioning

confidence: 99%

The model for end-stage liver disease (MELD)

2007

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The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The major use of the MELD score has been in allocation of organs for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver trans- becoming the standard by which priorities in donor liver allocation were determined. Since the score was first derived in a relatively small number of patients undergoing the transjugular intrahepatic portosystemic shunts (TIPS) procedure, it has been validated in many different populations of patients with liver disease. Within a relatively short period of time, MELD became a common metric by which the severity of liver disease could be accurately described.In this paper, we review the initial development and validation of the MELD score, its application in organ allocation and management of patients with a variety of liver conditions, its strengths and limitation, and current and future efforts to refine and improve it further. Creation and Validation of MELDMELD was initially created to predict survival following elective placement of TIPS. 1 The model was subsequently validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity (e.g., hospitalized and ambulatory patients), as well as patients of geographically and temporally diverse origin. 2 The survival model was initially termed the "Mayo End-Stage Liver Disease" or "MELD" model to acknowledge the affiliation of the investigators who created the model. During discussions leading to the establishment of MELD as the basis for prioritization of organs for liver transplantation, 3,4 we changed the name to "Model for End-Stage Liver Disease" which maintained the acronym "MELD", but removed the association with a particular institution, a process that was thought would lead to wider acceptance of the model. MELD incorporates 3 widely available laboratory variables including the international normalized ratio (INR), serum creatinine, and serum bilirubin. The original mathematical formula for MELD is: MELD ϭ 9.57 ϫ log e (creatinine) ϩ 3.78 ϫ Log e (total bilirubin) ϩ 11.2 ϫ Log e (INR) ϩ 6.43.The score can be calculated on handheld computing devices, and is available at www.mayoclinic.org/gi-rst/ mayomodel5.html. When the model was initially created the etiology of cirrhosis was also included. In the TIPS

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Evaluation of a Model to Predict Poor Survival in Patients Undergoing Elective TIPS Procedures

Cited by 38 publications

References 21 publications

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension†

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

The model for end-stage liver disease (MELD)

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