American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the significance of a MELD score less than 15 to 18 in the context of TIPS consideration?

1. Indicates better liver function

2. Indicates a requirement for hospitalization

3. Indicates a need for more aggressive diuretic therapy

4. Indicates higher risk for liver cancer

The correct answer is: Indicates better liver function

A MELD score (Model for End-Stage Liver Disease) is a critical tool used to assess the severity of liver disease and prioritize patients for liver transplantation. A MELD score of less than 15 to 18 generally indicates better liver function compared to higher scores. This lower score suggests that the patient may not be experiencing severe complications related to their liver disease, such as liver failure or significant portal hypertension, which are key considerations when deciding about the transjugular intrahepatic portosystemic shunt (TIPS) procedure. In the context of TIPS, a lower MELD score suggests that the patient may have a better overall prognosis and stability concerning their liver function and that the complications requiring TIPS intervention, such as refractory ascites or variceal bleeding, may not yet be present. Consequently, patients with a MELD score in this range might not be ideal candidates for TIPS since the procedure is typically reserved for those with more significant liver impairment where the risks of non-intervention outweigh the procedural risks. In summary, a MELD score less than 15 to 18 signifies better liver function and might suggest that a patient does not urgently require interventions like TIPS, allowing for other medical management strategies to be explored first.