However, the TIPS procedure is sometimes blamed for the increased risk of death in patients with high MELD scores. 21, 22, 23 It is impossible in retrospective studies to separate the risk of death due to the condition that is the indication for the TIPS (such as intractable ascites, hepatic hydrothorax, or variceal hemorrhage) and death caused by the TIPS procedure as the two are confounded. 1, 2, 3, 4, 5, 6, 7 This high death rate could be because patients with high MELD scores have a higher risk of death than those with low MELD scores, 8, 9, 10, 11 or because they have a life‐threatening complication, such as intractable ascites 12, 13, 14 or variceal bleeding, 15, 16, 17, 18, 19, 20 which increases their risk of dying, or because the TIPS procedure itself increases the risk of death. Patients with high model for end‐stage liver disease (MELD) scores who undergo a transjugular intrahepatic portosystemic shunt (TIPS) procedure are at a high risk of dying after the procedure. However, the risk of death after TIPS was progressively lower than expected as the MELD score increased. There was an 80% lower incremental risk of death among patients with a MELD score ≥18 (hazard ratio for TIPS, 0.20 95% confidence interval, 0.03‐1.23) 6 months after the TIPS procedure.Ĭonclusion: Risk of death is associated with underlying disease severity as shown by the MELD score and the need for TIPS, and both history of TIPS and high MELD score independently increased the risk of mortality. Patients with MELD scores ≥18 had a 51% lower incremental risk of death (lower risk than would be expected from the combined independent risks of MELD and needing/receiving TIPS) associated with TIPS than patients with MELD scores <18 (hazard ratio for TIPS, 0.49 95% confidence interval, 0.10‐2.45) in the first 6 months following TIPS. We found a negative interaction between a high MELD score and a history of TIPS, with potentially important effect sizes. We performed Cox proportional hazard regression, including both TIPS and MELD as time‐dependent covariates together with their interaction, to calculate the impact of TIPS on the risk of death associated with a high MELD score. We analyzed the interaction between TIPS and MELD in 106 patients with TIPS and 79 with intractable ascites without TIPS. We aimed to determine if TIPS increased the risk of death in these patients. Physicians often exclude patients with a model for end‐stage liver disease (MELD) score ≥ 18 from a transjugular intrahepatic portosystemic shunt (TIPS) procedure due to the concern for higher risk of death.
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