Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt

Angermayr, Bernhard

doi:10.1136/gut.52.6.879

Cited by 265 publications

(231 citation statements)

References 47 publications

Supporting

Mentioning

199

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Wallace

Madoff

Ahrar

et al. 2004

Cancer

View full text Add to dashboard Cite

show abstract

“…MELD has shown an advantage over CP by using continuous objective variables that are not open to observer interpretation and are appropriately weighted according to their impact on prognosis [3,4,26] . Its ability to predict mortality, however, has been found to be similar or slightly superior to the traditional CP score [27][28][29][30] . These controversies suggest that a better predictive model is necessary to predict survival in cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Vilar‐Gomez¹,

Bertot²,

Oramas³

et al. 2009

WJG

View full text Add to dashboard Cite

AIM:To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients. METHODS:We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52-and 104-wk survival. The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk ≤ 8 and high risk > 8). RESULTS:In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52-and 104-wk mortality, respectively. In addition, the HosmerLemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77). CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

show abstract

“…TIPS is a well established procedure for patients with portal hypertension complications such as acute bleeding and rebleeding of gastroesophagic varices refractory to clinic endoscopic treatment (1) . TIPS has been used mainly for variceal bleeding, but seems to be efficient in refractory ascites as well (7) .…”

Section: Discussionmentioning

confidence: 99%

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience

Funes

Silva

Arroyo

et al. 2012

Arq. Gastroenterol.

View full text Add to dashboard Cite

-Context -Transjugular intrahepatic portosystemic shunt (TIPS) is the non-surgical treatment option with low level of morbi-mortality and possibility of accomplishment in patients with severe hepatic dysfunction which aims at decompressing the portal system treating or reducing the portal hypertension complications. ). Global mortality occurred in 41 (60.3%). Conclusions -Mortality is directly related to clinical factors of patients, being Child-Pugh and MELD classifications predictors of mortality, with more impact in patients with Child-Pugh class C and MELD > 15. The complications found were similar to those described in the literature, although the dysfunction by stent stenosis (26.4%) was lower than in the most of the studies and the encephalopathy incidence (58.3%) was higher. Probably, the high incidence of encephalopathy is explained by the low incidence of stenosis. HEADINGS -Portasystemic shunt, transjugular intrahepatic. Hypertension, portal.Estudo não apresenta conflito de interesses.

show abstract

Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt

Cited by 265 publications

References 47 publications

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Transjugular intrahepatic portosystemic shunts: Experience in the oncology setting

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Mortality and complications in patients with portal hypertension who underwent transjugular intrahepatic portosystemic shunt (TIPS) - 12 years experience

Contact Info

Product

Resources

About