MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt

J Hepatol. 2002 Apr;36(4):494-500. doi: 10.1016/s0168-8278(01)00309-9.


Background/aims: Patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) are at risk of early death due to end-stage liver failure. The aim of this study was to compare model of end-stage liver disease (MELD) and Child-Pugh scores as predictors of survival after TIPS.

Methods: We studied 140 cirrhotic patients treated with elective TIPS. Concordance (c)-statistic was used to assess the ability of MELD or Child-Pugh scores to predict 3-month survival. The prediction of overall survivals was estimated by comparing actuarial curves of subgroups of patients stratified according to either Child-Pugh scores or MELD risk scores.

Results: During a median follow-up of 23.7 months, 55 patients died, 14 underwent liver transplantation and seven were lost to follow-up. For 3-month survival, the discrimination power of MELD score was superior to Child-Pugh score (0.84 vs. 0.70, z=2.07; P=0.038). Unlike Pugh score, MELD score identified two subgroups of Child C patients with different overall survivals (P=0.027). The comparison between observed and predicted survivals showed that MELD score overrates death risk.

Conclusions: MELD score is superior to Child-Pugh score as predictor of short-term outcome after TIPS. Its accuracy, however, decreases for long-term predictions.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Actuarial Analysis
  • Adolescent
  • Adult
  • Aged
  • Female
  • Humans
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / physiopathology
  • Liver Cirrhosis / surgery*
  • Male
  • Middle Aged
  • Models, Theoretical*
  • Portasystemic Shunt, Transjugular Intrahepatic / mortality*
  • Prognosis
  • Survival Analysis
  • Treatment Outcome