Korean J Radiol.  2009 Oct;10(5):481-489. 10.3348/kjr.2009.10.5.481.

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

• Tzeng WS
• Wu RH
• Lin CY
• Chen JJ
• Sheu MJ
• Koay LB
• Lee C

• KMID: 1093963
• DOI: http://doi.org/10.3348/kjr.2009.10.5.481

Abstract

OBJECTIVE
This 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 METHODS: Data 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. RESULTS: No 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). CONCLUSION: A 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.

Keyword

Hepatitis; Viral cirrhosis; Mortality; Prognosis; Transjugular intrahepatic portosystemic shunt (TIPS)

MeSH Terms

Emergency Treatment
Esophageal and Gastric Varices/*mortality/*surgery
Female
Humans
Male
Middle Aged
Portasystemic Shunt, Transjugular Intrahepatic/*mortality
Predictive Value of Tests
Prognosis
Proportional Hazards Models
ROC Curve
Retrospective Studies
Survival Analysis

Figure

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  Fig. 1 Kaplan-Meier 360-day survival curves based on (A) acute physiology and chronic health evaluation scores, (B) Child-Pugh scores and (C) model for end-stage liver disease scores. Tertile difference for 30-day, 60-day and 360-day survival was significant (log-rank test, all p < 0.01).

• 

  Fig. 2 Receiver operating characteristics curves for acute physiology and chronic health evaluation, Child-Pugh and model for end-stage liver disease for (A) 30-day, (B) 60-day, and (C) 360-day mortality.

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