To Explore The Predictive Value Of MELD,MELD-Na,MELD-AS,iMELD And MESO Scoring Systems For The Occurrence Of Hepatic Encephalopathy After TIPs Treatment

Objective: To explore the predictive value of MELD, MELD-Na, MELD-AS, i MELD and MESO scoring systems for the occurrence of hepatic encephalopathy after TIPS treatment.Method: The clinical data of 33 patients with hepatocirrhosis who received TIPS successfully in Suining Central Hospital from Feb 2011 to Feb 2014 were retrospectively analyzed. All the patients were followed up for one year at post-TIPS. All the patients were divided into two groups(N-HE and HE). MELD, MELD-Na, MELD-AS, i MELD and MESO were calculated respectively for each patient at pre-TIPS and the comparative analysis was performed.Result:1. In the cohort of 33 patients, Hepatic encephalopathy occurred in 10 patients. Hepatic encephalopathy for the first time occurred within 6 months after TIPS. One case died of recurrent attacks of hepatic encephalopathy and liver failure at post-TIPS 11 months. The rest of 9 cases were cured with positive medical comprehensive therapy. Between N-HE group and HE group, The difference of gender, age, and etiology had no statistical significance(P > 0.05).2. The values of TB(18.49±5.70μmol/L vs28.90±4.83μmol/L), Cr(60.40±10.16μmol/Lvs76.50±12.39μmol/L), Na(139.29±10.59mmol/L vs 133.95±3.59mmol/L) and INR(1.42±0.26vs1.68±0.26) were significantly higher in HE group than those in N-HE group(P<0.05).3. The values of MELD( 6.23±3.15vs12.25±2.19), MELD-Na(7.07±3.51vs15.35±5.24),MELD-AS(8.92±4.76vs17.86±4.88), i MELD( 22.97±4.12vs35.32±6.80) and MESO( 0.45±0.23vs0.91±0.17) were significantly higher in HE group than those in N-HE group(P<0.05).4. AUC generated by ROC of MELD, MELD-Na, MELD-AS, i MELD and MESO was 0.942, 0.908, 0.917, 0.967 and 0.933, respectively. AUC was calculated and compared by Z-test. AUC of i MELD was 0.976, higher than AUC of the other four scoring systems. The difference of AUC between i MELD and MELD, MELD-Na, MELD-AS and MESO had statistical significance(P < 0.05). But besides i MELD, the other scoring systems’ difference was no statistical significance(P>0.05). The critical values of MELD, MELD-Na, MELD-AS, i MELD and MESO were 9.255, 10.780, 12.515, 28.210 and 0.685.Conclusion:1. Gender, age and etiology had no effect on the occurrence of hepatic encephalopathy after TIPS treatment.2. Hepatic encephalopathy for the first time occurred mostly within 6 months after TIPS, most of the cases could be cured with positive medical comprehensive therapy.3. The higher the score,the greater the risk of the occurrence of hepatic encephalopathy.4. MELD, MELD-Na, MELD-AS, i MELD and MESO scoring systems all had good predictive value for the occurrence of hepatic encephalopathy after TIPS treatment. But i MELD scoring system had certain advantage on predicting the occurrence of hepatic encephalopathy after TIPS and made up for the lack of MELD, MELD-Na, MELD-AS and MESO.