*Internal normalized ratio for prothrombin time. The predicted probability of death within 3 months of placement of TIPS is read off this scale. The point on the middle scale is connected to creatinine and the line extended to the predicted probability scale. Connect the bilirubin to the INR and extend the line to the middle scale. To use the nomogram the actual values of bilirubin (mg/dL), INR for prothrombin time, and creatinine (mg/dL) are plotted. The authors of this study developed a nomogram that could be used to predict the likelihood of dying within 3 months after placement of TIPS and all you need is a ruler to measure it!Ĭaption from original Malinchoc et al paper: "Nomogram for predicting the probability of death within 3 months of placement of TIPS stent for patients with cirrhosis due to alcoholic or cholestatic liver disease. In the original study conducted in 2000, assessing the performance of the model, MELD was better able to predict survival compared to the Child-Pugh classification in 231 patients undergoing TIPS for prevention of variceal rebleeding or for refractory ascites. The MELD model was originally developed to assess short-term prognosis of patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures. a patient with a bilirubin of 4 mg/dL is assigned the same number of points as a patient with a bilirubin of 15 mg/dL!)Ĭlearly, we needed a better system to prioritize patients on the liver transplant waiting list. Not all were equal! A patient with a variceal bleed and a bilirubin of 30 could share this status with a patient with refractory ascites
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