S2885 Is MELD 3.0 Better Than MELD and MELD-Na in Predicting Mortality and Development of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)?

Introduction: Model for End-Stage Liver Disease (MELD) and MELD-Na are important predictive models in patients receiving transjugular intrahepatic portosystemic shunt (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 (man and woman) 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. Conclusion: 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.