MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort

Casadaban, Leigh C.; Parvinian, Ahmad; Zivin, Sean P.; Lakhoo, Janesh; Minocha, Jeet; Knuttinen, M. Grace; Ray, Charles E.; Bui, James T.; Gaba, Ron C.

doi:10.1016/s1665-2681(19)31278-5

Cited by 41 publications

(30 citation statements)

References 26 publications

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“…This finding is in contrast with that of a recent study by Casadaban et al . of 101 patients undergoing TIPSS insertion for variceal haemorrhage23. This study identified MELD score to be predictive of 90 day mortality.…”

Section: Discussionmentioning

confidence: 89%

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Lipopolysaccharide-Induced Neutrophil Dysfunction Following Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion is Associated with Organ Failure and Mortality

Macnaughtan

Mookerjee

Merwe

et al. 2017

Sci Rep

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Systemic lipopolysaccharide (LPS) is implicated in increasing mortality in patients with alcoholic hepatitis but the underlying mechanisms are not well characterised. The objective of this study was to characterise neutrophil function, LPS and cytokine concentrations within the splanchnic circulation of alcoholic cirrhotic patients undergoing TIPSS insertion for variceal haemorrhage and correlate this with outcome. 26 patients with alcoholic cirrhosis and variceal haemorrhage were studied prior to and 1-hour after TIPSS insertion. Neutrophil function, LPS and cytokine concentrations were determined in arterial, hepatic venous (HV) and portal venous blood (PV). Significantly higher LPS concentrations and neutrophil reactive oxidant species (ROS) production were observed in PV vs HV blood. Cross-incubation of HV plasma with PV neutrophils resulted in reduced ROS production. Insertion of TIPSS was associated with a significant increase in arterial LPS concentrations and deterioration in neutrophil phagocytosis. Number of organ failures and arterial IL-6 concentrations at presentation were associated with increased mortality. The portal circulation has a distinct immunological milieu characterised by a pathological neutrophil phenotype and an anti-inflammatory cytokine profile associated with heightened LPS levels. TIPSS insertion renders this neutrophil functional defect systemic, associated with an increase in arterial LPS and a susceptibility to sepsis.

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Section: Discussionmentioning

confidence: 89%

“…Casadaban et al . described non-alcoholic aetiology as predictive of increased mortality on multivariate analysis23 which may be a function of diminished regenerative potential compared to patients with alcoholic cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Lipopolysaccharide-Induced Neutrophil Dysfunction Following Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion is Associated with Organ Failure and Mortality

Macnaughtan

Mookerjee

Merwe

et al. 2017

Sci Rep

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“…Satsangi reinforces the value of MELD in predicting bad outcome and survival after TIPS placement but in the clinical scenario of emergent TIPS in variceal bleeding after pharmacological and/or endoscopic treatment failure and in refractory ascites …”

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confidence: 71%

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Hernández‐Gea

García‐Pagán

2019

Hepatology

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“…widely used prognostic model in patients with cirrhosis is the Child-Pugh score which is developed as a model to predict survival of portacaval shunt [4,7]. A relatively new approach is the MELD score which was initially used as a prognostic indicator for patients undergoing elective TIPS [6,8]. The ME L D score was widely employed for patient selection and allocation of or-gans among patients awaiting liver transplantation because of its reproducibility, objectivity [7]. In the Child-Pugh scoring system, bilirubin and prothrombin time can accurately refl ect the liver function.…”

Section: C-statisticsmentioning

confidence: 99%

Comparison of MELD and Child- Pugh Score for the Prediction of Survival in Portal Hypertension Undergoing Transjugular Intrahepatic Portosystemic Shunt

Kai¹,

Shikai²,

Xingjiang³

et al. 2017

Int J Vasc Surg Med

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Objectives: Recently, the model for End-Stage Liver Disease (MELD) was proposed for the prediction of survival in transjugular intrahepatic portosystemic shunt (TIPS) patients. We therefore compared the prognostic accuracy of the MELD model and the Child-Pugh score, in an unselected cohort of TIPS patients followed long-term. Methods: A retrospective chart review and statistical analyses were done on 120 patients consecutively admitted for portal hypertension from 2009 to 2013 in the Jinling hospital (Nanjing, China). Results: The survival rate for all patients was 95.8% at 3 months, 90% at 1 year, and 85.8% at 3 years. Signifi cantly lower survival rates were found in patients with MELD scores of 15 or more in comparison to those with MELD scores of 15 or less (p<0.001).There was no signifi cant difference in survival rate between patients with Child-Pugh classifi cation A and those with Child-Pugh classifi cation B, while the patients with Child-Pugh classifi cation C has a signifi cantly lower survival rate than those with Child-Pugh classifi cation A and B (p<0.001). The discrimination powers of MELD (c statistics: 0.772, 0.680, 0.647 for 3-month, 1-year, and 3-year survival) were not signifi cantly different from the discrimination powers of Child-Pugh score at the same time points (c statistics: 0.795, 0.732, 0.678). Conclusions: The Child-Pugh classifi cation is only slightly superior to the MELD score for the prediction of long-term survival in TIPS patients. Therefore, the search continues for an entirely new scoring system to further improve prognostic accuracy.

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MELD score for prediction of survival after emergent TIPS for acute variceal hemorrhage: derivation and validation in a 101-patient cohort

Cited by 41 publications

References 26 publications

Lipopolysaccharide-Induced Neutrophil Dysfunction Following Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion is Associated with Organ Failure and Mortality

Lipopolysaccharide-Induced Neutrophil Dysfunction Following Transjugular Intrahepatic Portosystemic Stent Shunt (TIPSS) Insertion is Associated with Organ Failure and Mortality

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Comparison of MELD and Child- Pugh Score for the Prediction of Survival in Portal Hypertension Undergoing Transjugular Intrahepatic Portosystemic Shunt

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