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[MELD score in prediction of early mortality in patients suffering refractory ascites treated by TIPS].
Vnitr Lek. 2006 Sep; 52(9):771-6.VL

Abstract

Transjugular Intrahepatic Portosystemic Shunt (TIPS) is now well established in the treatment of complications of symptomatic portal hypertension such as acute or recurrent variceal bleeding, refractory ascites and Budd-Chiari syndrome. In some patients with refractory ascites who belong to group C according to Child-Pugh classification (score around 12), the indication of the procedure could be very questionable and early mortality is quite high. However, in some cases, the subgroup of such risky patients can profit from TIPS. Child-Pugh classification is used for the stratification of the patients routinely. During the last decade other scoring systems occured to bring a better prognostic value. MELD (Model for End stage Liver Disease) score, based only on laboratory values is one of them. Comparison of these two scoring systems in patients treated by TIPS in previous trials brought certain discrepancy, but MELD score seems to be better in predicting early mortality. The aim of our study was to determine retrospectively the predictive accuracy of MELD score for the early mortality in comparison to Child-Pugh score in patients treated for refractory ascites by TIPS.

METHODS

We evaluated 110 patients (mean age 55 years) with liver cirrhosis (61% of patients with alcoholic etiology), who underwent TIPS for refractory ascites in our center from September 1992 to December 2003. MELD and Child-Pugh score was calculated and then compared between groups with early (one month), three month and one year mortality, and those who survived over this period (one, three and twelve months), comparing MELD and Child-Pugh score (ROC analysis and Student's T test were used).

RESULTS

Mean follow up was 23 months. Average MELD score in the whole group was (16). In patients, who died within one month the score before TIPS was 21, three months 20 and 18 one year. Comparing MELD score between subgroups and then Child-Pugh score, only for MELD score there was a statistically significant difference (p < 0.05) in one month. Using ROC (AUC) analysis, discriminant power of MELD score was superior to Child-Pugh score for one (0.73 vs 0.63) and three month (0.73 vs 0.67) mortality. The discriminant power for one year mortality was low in both scores.

CONCLUSION

MELD scoring system is a better tool to predict the risk of early mortality in patients with refractory ascites treated by TIPS than Child-Pugh classification. The discriminant power was low in both scores in one year horizon.

Authors+Show Affiliations

II. interní klinika Lékarské fakulty UK a FN Hradec Kralové. fejfar@fnhk.czNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

cze

PubMed ID

17091599

Citation

Fejfar, T, et al. "[MELD Score in Prediction of Early Mortality in Patients Suffering Refractory Ascites Treated By TIPS]." Vnitrni Lekarstvi, vol. 52, no. 9, 2006, pp. 771-6.
Fejfar T, Safka V, Hůlek P, et al. [MELD score in prediction of early mortality in patients suffering refractory ascites treated by TIPS]. Vnitr Lek. 2006;52(9):771-6.
Fejfar, T., Safka, V., Hůlek, P., Vanásek, T., Krajina, A., & Jirkovský, V. (2006). [MELD score in prediction of early mortality in patients suffering refractory ascites treated by TIPS]. Vnitrni Lekarstvi, 52(9), 771-6.
Fejfar T, et al. [MELD Score in Prediction of Early Mortality in Patients Suffering Refractory Ascites Treated By TIPS]. Vnitr Lek. 2006;52(9):771-6. PubMed PMID: 17091599.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [MELD score in prediction of early mortality in patients suffering refractory ascites treated by TIPS]. AU - Fejfar,T, AU - Safka,V, AU - Hůlek,P, AU - Vanásek,T, AU - Krajina,A, AU - Jirkovský,V, PY - 2006/11/10/pubmed PY - 2007/1/12/medline PY - 2006/11/10/entrez SP - 771 EP - 6 JF - Vnitrni lekarstvi JO - Vnitr Lek VL - 52 IS - 9 N2 - UNLABELLED: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is now well established in the treatment of complications of symptomatic portal hypertension such as acute or recurrent variceal bleeding, refractory ascites and Budd-Chiari syndrome. In some patients with refractory ascites who belong to group C according to Child-Pugh classification (score around 12), the indication of the procedure could be very questionable and early mortality is quite high. However, in some cases, the subgroup of such risky patients can profit from TIPS. Child-Pugh classification is used for the stratification of the patients routinely. During the last decade other scoring systems occured to bring a better prognostic value. MELD (Model for End stage Liver Disease) score, based only on laboratory values is one of them. Comparison of these two scoring systems in patients treated by TIPS in previous trials brought certain discrepancy, but MELD score seems to be better in predicting early mortality. The aim of our study was to determine retrospectively the predictive accuracy of MELD score for the early mortality in comparison to Child-Pugh score in patients treated for refractory ascites by TIPS. METHODS: We evaluated 110 patients (mean age 55 years) with liver cirrhosis (61% of patients with alcoholic etiology), who underwent TIPS for refractory ascites in our center from September 1992 to December 2003. MELD and Child-Pugh score was calculated and then compared between groups with early (one month), three month and one year mortality, and those who survived over this period (one, three and twelve months), comparing MELD and Child-Pugh score (ROC analysis and Student's T test were used). RESULTS: Mean follow up was 23 months. Average MELD score in the whole group was (16). In patients, who died within one month the score before TIPS was 21, three months 20 and 18 one year. Comparing MELD score between subgroups and then Child-Pugh score, only for MELD score there was a statistically significant difference (p < 0.05) in one month. Using ROC (AUC) analysis, discriminant power of MELD score was superior to Child-Pugh score for one (0.73 vs 0.63) and three month (0.73 vs 0.67) mortality. The discriminant power for one year mortality was low in both scores. CONCLUSION: MELD scoring system is a better tool to predict the risk of early mortality in patients with refractory ascites treated by TIPS than Child-Pugh classification. The discriminant power was low in both scores in one year horizon. SN - 0042-773X UR - https://www.unboundmedicine.com/medline/citation/17091599/[MELD_score_in_prediction_of_early_mortality_in_patients_suffering_refractory_ascites_treated_by_TIPS]_ DB - PRIME DP - Unbound Medicine ER -