Prediction of Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation: Comparison of Albumin-Bilirubin Grade to Model for End-Stage Liver Disease Score

Objective: The albumin-bilirubin (ALBI) grade is a tool for assessing liver dysfunction in patients with cirrhosis and hepatocellular carcinoma that predicts survival. The model for end-stage liver disease (MELD) score was designed to predict survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. This study compared the ALBI and MELD scores for predicting survival after TIPS.

Materials and Methods: In this retrospective study, preprocedure ALBI and MELD score components and medical records were reviewed for 198 patients undergoing TIPS from 2005 to 2012. Survival after TIPS creation was estimated using the Kaplan–Meier method. Discriminatory ability was determined using the Cindex derived from Cox proportional hazards models.

Results: TIPS were created in cirrhotic patients with portal hypertension. There were 5 patients with an ALBI grade of 1, 76 patients with grade 2, and 117 patients with grade 3. The mean MELD score was 14. ALBI score, ALBI grade, and MELD were each significant predictors of 60-day mortality from hepatic failure and overall survival (p < 0.05). Based on the Cindex, the MELD score was a better predictor of 60-day and overall survival (Cindex=0.74 and 0.67) than ALBI score (0.70 and 0.63) or ALBI grade (0.63 and 0.60). When ALBI and MELD score were compared in a multivariate Cox proportional hazards model, MELD score was a significant predictor of 60-day and overall mortality (p = 0.0001 and p = 0.0004), whereas ALBI score was not (p = 0.19 and p = 0.14).

Conclusion: The ALBI score is a significant predictor of mortality after TIPS creation. However, the MELD score remains the superior predictor of mortality after TIPS.