Abstract No. 277 Comparison of Predictors of Early Mortality After TIPS Placement for ICU Patients with Acute Variceal Hemorrhage

This study was performed to identify the best predictors of 30-day mortality after TIPS placement among patients with acute variceal bleeding (AVB) in hemorrhagic shock in ICU. In a retrospective manner, all ICU patients with hemorrhagic shock due to AVB who underwent salvage or rescue TIPS placement between 07/2011 to 08/02023 were reviewed. Data included demographics, periprocedural hemodynamic and laboratory data, time between ED presentation to TIPS placement, and 30-day mortality. The MELD score, Child-Pugh score (CP), Rockall score, AIMS65 score, and Glasgow-Blatchford bleeding score were calculated. Area under receiver-operating characteristics (ROC) analysis was used to evaluate established scoring systems in predicting 30-day mortality. There were a total of 61 patients with a median age of 56 (IQR, 48-60). The most common cause of cirrhosis was EtOH (n=26, 41.3%), HCV (n=12, 19.0%), or NASH cirrhosis (n=10, 15.9%). 31 patients (49.2%) were on epinephrine or norepinephrine drips before or during TIPS placement. The median time between presentation to ED to TIPS placement was 60 hours (IQR, 27-178.5), and median transfused packed RBC before TIPS placement was 4 units (IQR, 3-6). The median MELD Na score was 18 (IQR, 13-22.5), the MELD score was 17 (IQR, 12.5-20.5), and the CP score was 9 (IQR, 8-13). Median Clinical Rockall, AIMS65, and Glasgow-Blatchford bleeding scores were 8 (IQR, 7-9), 3 (IQR, 2-4), 14 (IQR, 11.5-16), respectively. The overall 30-day mortality rate was 15.9%. MELD Na score appeared to have the highest accuracy in predicting 30-day mortality (AUC: 88.3%, OR:1.37, 95% CI: 1.17-1.78); this was followed by the MELD score (AUC: 86.6%, OR:1.34, 95% CI: 1.2-1.79), CP score (AUC: 78.9%, OR:1.73, 95% CI: 1.20-2.75) and AIMS65 score (AUC: 75.3%, OR:2.82, 95% CI: 1.23-9.46). ROC curves based on the time between ED admission to TIPS placement, Clinical Rockall Score, and Glasgow Blatchford score had an AUC of 70.2%, 62.5%, and 60.0%, respectively. The optimized threshold for predicting 30-day mortality was a MELD Na score of 22.5 (sensitivity: 70%, 1-specificity: 17%). The 30-day mortality rate in patients with MELD Na >22.5 was 43.8%, as opposed to 6.4% in patients with MELD Na< 22.5(OR: 11.4; p< 0.001). The MELD Na score appears to be a good predictor of 30-day mortality in ICU patients presenting with upper GI bleeding due to acute variceal bleeding.