Comparison of MELD Score Subcomponents versus Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Survival Time

Abstract

Abstract Background: Consequences of severe liver disease include hepatic biosynthetic and metabolic dysfunction, which is reflected in the model for end-stage liver disease (MELD) score subcomponents of elevated international normalized ratio (INR) and bilirubin. Hepatorenal complications also occur, indicated by increased serum creatinine in the MELD score. Serum creatinine should theoretically not be a strong predictor of survival after trans-jugular intrahepatic portosystemic shunt (TIPS) placement, as TIPS directly reduces portal hypertension but cannot correct irreversible damage to hepatic metabolic processes. We compared TIPS outcomes in chronic liver disease patients whose high MELD scores were caused primarily by elevated INR/Bilirubin versus patients whose MELD scores were caused primarily by elevated creatinine. Methods: This retrospective study identified 68 patients undergoing primary TIPS for chronic liver disease from 2018 to 2021. Patient characteristics, baseline MELD score, and MELD subcomponents were analyzed against post-TIPS survival time. Results: Baseline MELD (HR = 1.136, p = 0.002), total bilirubin (HR = 1.933, p < 0.001), and INR (HR = 4.107, p = 0.004) were found to be significant predictors of decreased survival following TIPS. Baseline creatinine was not found to be significantly related to survival time (HR = 1.654, p = 0.1726). Conclusions: Post-TIPS survival is negatively impacted by abnormalities of MELD subcomponents related to decreased hepatic biosynthetic function (INR, total bilirubin), but not subcomponents related to portal hypertension (creatinine) which TIPS directly alleviates. This differs from the original description of the scoring system, in which creatinine was shown to be an independent predictor of post-TIPS survival.