Liver

57 - Comparison of Outcomes After Transjugular Intrahepatic Portosytemic Shunt Placement in Cirrhotic Patients with High MELD-Na Score versus Low MELD-Na Score Presenting With Refractory Variceal Bleed

Wednesday, October 10
8:50 AM - 9:00 AM
Location: Terrace Ballroom 4 (level 400)

Category: Liver
Ashley Wood, DO1, Maria Del Pilar Bayona Molano, MD1, Rocio Lopez, MS2, Jamak M. Esfeh, MD1
1Cleveland Clinic Foundation, Cleveland, OH; 2Lerner Research Institute/Cleveland Clinic Foundation, Cleveland, OH

Introduction: Cirrhotic patients undergoing emergent TIPS for endoscopic refractory variceal bleed are usually critically ill and are at high risk for hepatic decompensation and death. We aimed to compare those with a high MELD-Na score (≥15) vs. a low MELD-Na score (<15) in this situation to look at the complications and survival between these groups and to see if the MELD-Na score was a reliable predictor of death.

Methods: This is a retrospective study of patients who underwent TIPS for refractory variceal bleed between 2013 and 2017 at the Cleveland Clinic.  Patients with cirrhosis, diagnosed by liver biopsy or image findings combined with evidence of portal hypertension, were identified. These patients also had variceal bleeding despite endoscopic intervention with a mean of 1.5 scopes prior to TIPS. 30 patients had a high MELD-Na score and 45 had a low MELD-Na score.  Multivariable analysis and linear regression were performed to assess association between groups and outcomes of interest. Survival analysis was examined with a Kaplan-Meier plot.

Results: The average age of the 75 patients was 55±13 and 64% were male. 40% of patients had a high MELD-Na score ranging between 15 and 48 with a mean of 24±7.8. MELD-Na ranged between 6 and 14 with a mean of 9.4± 2 in the low group. In the high MELD-Na group, 11 were Child-Turcotte-Pugh (CTP) Class B and 19 were C. For those with a low score, 13 were CTP A, 31 CTP B, and 1 CTP C [Table 1]. The most common complications after TIPS for the high MELD-Na vs. low MELD-Na groups included acute kidney injury (37% vs. 0%), infection (23% vs. 8%), hepatic encephalopathy (23% vs. 4%), and hemorrhagic shock (27% vs. 2%) [Table 2]. Subjects with a high MELD-Na required an average of 4 units of blood in the first 48 hours while those with a low score required 2. Those with a high MELD-Na had longer post-TIPS intubation time (3 days vs. 1 day) and a longer ICU stay (4 days vs. 3 days).  Post-TIPS follow up ranged from 0 to 55.6 months with a median of 7.8 months. A total of 16 patients (12 during TIPS hospitalization) in the high MELD-Na group and 9 (2 during TIPS hospitalization) in the low MELD-Na group died [Figure 1].

Discussion: Those with a MELD-Na score ≥15 do worse after TIPS placement for endoscopic refractory variceal bleed. The MELD-Na score is a reliable predictor for risk stratification and survival after emergent TIPS.  With a MELD-Na ≥15 both family and patient should be informed about their guarded prognosis.


Disclosures:
Ashley Wood indicated no relevant financial relationships.
Maria Del Pilar Bayona Molano indicated no relevant financial relationships.
Rocio Lopez indicated no relevant financial relationships.
Jamak Esfeh indicated no relevant financial relationships.

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57 - Comparison of Outcomes After Transjugular Intrahepatic Portosytemic Shunt Placement in Cirrhotic Patients with High MELD-Na Score versus Low MELD-Na Score Presenting With Refractory Variceal Bleed



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