Combination of Model for End-Stage Liver Disease (MELD) and Sarcopenia predicts mortality after transjugular intrahepatic portosystemic shunt (TIPS)

Maria Gabriela Delgado; Nando Mertineit; Jaime Bosch; Iris Baumgartner; Annalisa Berzigotti

doi:10.1016/j.dld.2024.03.003

Combination of Model for End-Stage Liver Disease (MELD) and Sarcopenia predicts mortality after transjugular intrahepatic portosystemic shunt (TIPS)

Dig Liver Dis. 2024 Mar 29:S1590-8658(24)00303-7. doi: 10.1016/j.dld.2024.03.003. Online ahead of print.

Authors

Maria Gabriela Delgado¹, Nando Mertineit², Jaime Bosch³, Iris Baumgartner⁴, Annalisa Berzigotti⁵

Affiliations

¹ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Center for Vascular Interventions (IZI), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Center for Vascular Interventions (IZI), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medical Radiology, Buergerspital Solothurn, Solothurner Spitäler, Solothurn, Switzerland.
³ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
⁴ Vasc Alliance AG, Schänzlihalde 1, 3013 Bern, Switzerland.
⁵ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Center for Vascular Interventions (IZI), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: annalisa.berzigotti@insel.ch.

PMID: 38555198
DOI: 10.1016/j.dld.2024.03.003

Abstract

TIPS is the most effective treatment for portal hypertension. Patient selection remains important to achieving optimal post-TIPS outcomes. The study evaluates 1-year mortality factors in cirrhotic patients receiving TIPS.

Methods: 87 cirrhotic patients received a TIPS between 2015 - 2021. Predictors of 1-year and overall mortality were assessed by estimating cumulative incidence functions and Grey's test to adjust for liver transplantation as a risk competing with mortality. Variables with p < 0.05 were checked for collinearity and included in the multivariate Cox proportional hazards model. Model discrimination was evaluated by calculating the area under the ROC curve.

Results: 87 patients were included (68% men; 22% ≥70 years). ALD was the primary cirrhosis cause. Most patients were Child-Pugh class B, MELD-Na score was 13.6 ± 6.0 points. The most frequent indication for TIPS was bleeding (51.7%), followed by refractory ascites (42.5%). The variables positively associated with mortality in univariate analysis were ascites, clinically overt sarcopenia and MELD-Na score, while ongoing nutritional supplementation improved survival. In the multivariate analysis, only clinically overt sarcopenia and MELD-Na score remained independently associated with mortality. A MELD-Na/sarcopenia model demonstrated a good discrimination, AUROC: 0.86 (95% CI 0.77 - 0.95).

Conclusion: MELD-Na score, and sarcopenia were significantly associated with 1-year survival in cirrhotic patients who received TIPS.

Keywords: Cirrhosis; MELD-Na score; Mortality; Sarcopenia; Transjugular intrahepatic portosystemic shunt (TIPS).