Prediction of Mortality after Emergent Transjugular Intrahepatic Portosystemic Shunt Placement: Use of APACHE II, Child-Pugh and MELD Scores in Asian Patients with Refractory Variceal Hemorrhage

Abstract

ObjectiveThis study was designed to determine if existing methods of grading liver function that have been developed in non-Asian patients with cirrhosis can be used to predict mortality in Asian patients treated for refractory variceal hemorrhage by the use of the transjugular intrahepatic portosystemic shunt (TIPS) procedure.Materials and MethodsData for 107 consecutive patients who underwent an emergency TIPS procedure were retrospectively analyzed. Acute physiology and chronic health evaluation (APACHE II), Child-Pugh and model for end-stage liver disease (MELD) scores were calculated. Survival analyses were performed to evaluate the ability of the various models to predict 30-day, 60-day and 360-day mortality. The ability of stratified APACHE II, Child-Pugh, and MELD scores to predict survival was assessed by the use of Kaplan-Meier analysis with the log-rank test.ResultsNo patient died during the TIPS procedure, but 82 patients died during the follow-up period. Thirty patients died within 30 days after the TIPS procedure; 37 patients died within 60 days and 53 patients died within 360 days. Univariate analysis indicated that hepatorenal syndrome, use of inotropic agents and mechanical ventilation were associated with elevated 30-day mortality (p < 0.05). Multivariate analysis showed that a Child-Pugh score > 11 or an MELD score > 20 predicted increased risk of death at 30, 60 and 360 days (p < 0.05). APACHE II scores could only predict mortality at 360 days (p < 0.05).ConclusionA Child-Pugh score > 11 or an MELD score > 20 are predictive of mortality in Asian patients with refractory variceal hemorrhage treated with the TIPS procedure. An APACHE II score is not predictive of early mortality in this patient population.

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

“…Most of the reports found in the literature show a follow-up shorter than this study's which was during a 12-year period, being observed only two long term studies of 10-year followup (27,28) . This study shows early death occurrence in 19 (26.4%) patients and global mortality of 41 (60.3%) patients.…”

“…This study shows early death occurrence in 19 (26.4%) patients and global mortality of 41 (60.3%) patients. Thus, global mortality rate is similar to or inferior when compared to long term studies as Yoon et al (28) (58.9%) and Tzeng et al (27) (77%). Yet, early mortality which independs on the follow-up period presents similar rating to those shown in literature as in Zhuang et al (30) (22.3%), Chalasani et al (5) (23.2%), Tzeng et al (27) (28%).…”

“…Thus, global mortality rate is similar to or inferior when compared to long term studies as Yoon et al (28) (58.9%) and Tzeng et al (27) (77%). Yet, early mortality which independs on the follow-up period presents similar rating to those shown in literature as in Zhuang et al (30) (22.3%), Chalasani et al (5) (23.2%), Tzeng et al (27) (28%). In Kisilevzky's (17) study with 44 patients, no statistically significant difference in global mortality of patients who underwent TIPS was found when compared to those performed in elective indication or urgency, whose results corroborate those found in this study.…”

“…Studies of Tzeng et al (27) , with 107 patients followed by a 10-year period, report that there were not deaths during TIPS procedure, but 82 (77%) from the patients died during the observation period. Thirty (28%) patients had early death and 53 (50%) died within 1 year.…”

Clinical profile, natural history, and predictors of mortality in patients with acute-on-chronic liver failure (ACLF)

“…We also evaluated the possible correlation between outcomes and various clinical and laboratory parameters and severity scores. The severity scores evaluated for mortality were Child-Pugh (CP) [11], Model for End-Stage Liver Disease (MELD) [12], Model for End-Stage Liver Disease-Na (MELD-Na) [13], SOFA, and Acute Physiology and Chronic Health Evaluation II (APACHE II) [14]; these were all calculated within 48 h of admission. Furthermore, the presence of positive systemic inflammatory response syndrome (SIRS) criteria at admission was also correlated with patients' outcome.…”