P5910 - Is MELD 3.0 Better Than MELD and MELD-Na in Predicting Mortality and Development of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)?

Gavisha Waidyaratne, MD¹, Sandya Liyanarachchi, MSc, MAS², Mina Makary, MD¹, Khalid Mumtaz, MBBS, MSc¹
1The Ohio State University Wexner Medical Center, Columbus, OH; 2The Ohio State University College of Medicine, Columbus, OH

Introduction: Model for End-Stage Liver Disease (MELD) and MELD-Na are important predictive models in patients receiving TIPS. Higher MELD and MELD-Na scores are associated with increased risk of hepatic encephalopathy and higher mortality after TIPS. MELD 3.0 has been the latest addition to further predict overall waitlist mortality and improve equitability in transplant allocation. Studies addressing predictive capability of MELD 3.0 for outcomes after TIPS are limited with variable results.

Methods: We included adult patients with cirrhosis who underwent TIPS at OSU between 2000 and 2018. Primary outcomes studied were 30-day mortality, 1-year mortality, and inpatient encounter for HE at 30-days and 1-year. The area under the curve (AUC) was calculated for MELD, MELD-Na, and MELD 3.0.

Results: A total of 227 patients were included. The average MELD, MELD-Na, and MELD 3.0 of the cohort were 14, 15, and 17 respectively. The AUC for MELD, MELD-Na, and MELD 3.0 for prediction of 30-day mortality was 0.76, 0.72, and 0.78 respectively (p > 0.11). The AUC for MELD, MELD-Na, and MELD 3.0 for prediction of 1-year mortality was 0.71, 0.70, and 0.73 respectively (p > 0.20). The AUC for MELD, MELD-Na, and MELD 3.0 for prediction of 30-day encounter for HE was 0.62, 0.61, and 0.62 respectively (p > 0.55). The AUC for MELD, MELD-Na, and MELD 3.0 for prediction of 1-year encounter for HE was 0.68, 0.68, and 0.67 respectively (p > 0.48). Sub-group analysis based on gender (male and female) also showed no statistically significant difference between the AUCs of MELD, MELD-Na, and MELD 3.0 for 30-day/1-year mortality and 30-day/1-year encounter for HE (Tables 1 and 2).

Discussion: No difference is mortality and development of HE was found based on various types of MELD scores i.e., MELD, MELD-Na and MELD 3.0. Our study supports existing data that MELD 3.0 is similar to MELD and MELD-Na in its predictive capabilities of mortality and development of HE post-TIPS.


Figure: Table 1: Area Under the Curve for MELD, MELD-Na and MELD 3.0 predicting mortality


Figure: Table 2: Area Under the Curve for MELD, MELD-Na and MELD 3.0 predicting HE

Disclosures:
Gavisha Waidyaratne indicated no relevant financial relationships.
Sandya Liyanarachchi indicated no relevant financial relationships.
Mina Makary indicated no relevant financial relationships.
Khalid Mumtaz indicated no relevant financial relationships.

Gavisha Waidyaratne, MD¹, Sandya Liyanarachchi, MSc, MAS², Mina Makary, MD¹, Khalid Mumtaz, MBBS, MSc¹. P5910 - Is MELD 3.0 Better Than MELD and MELD-Na in Predicting Mortality and Development of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)?, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.