MELD score as a prognostic model for listing acute liver failure patients for liver transplantation.
OBJECTIVE
The King's College Hospital (KCH) criteria are widely used for listing patients with acute liver failure (ALF) for liver transplantation (LT). Recent reports have suggested that the Model for End-Stage Liver Disease (MELD) score may be useful in assessing prognosis in ALF (nonparacetamol). This study compares prognostic accuracy of the two systems in patients with paracetamol (POD)-induced ALF treated in this unit.


METHODS
Seventy-two patients (average age 38 years; F:M ratio 2:1) admitted from 1994 to 2005 with POD-related ALF were studied. Clinical and biochemical parameters were recorded. The effect of applying a MELD score of greater than 30 as listing criteria for LT was calculated and compared with the KCH criteria. Outcomes were defined as LT, death, or full recovery.


RESULTS
Thirty-one patients (43%) recovered with medical therapy, 29 (40%) patients died, and 12 (17%) underwent LT. Sixty five percent of patients had a MELD > 30 and therefore could potentially be listed on admission; however, using KCH criteria only 24% patients were listed immediately. Sensitivity and negative predictive value of MELD was higher then KCH; however, we found KCH to have much higher specificity and positive predictive value.


CONCLUSIONS
MELD has higher sensitivity and negative predictive value for POD-induced ALF than the KCH criteria. However, the high false-positive rate associated with MELD limits its clinical utility. The high negative predictive value of MELD score may allow it to be used in conjunction with KCH criteria to avoid unneeded LT in patients who will likely recover spontaneously.
Zaman
M B
MB
National Liver Unit, St Vincent's University Hospital, Elm Park, Dublin-4, Ireland. zaman@esatclear.ie
Hoti
E
E
Qasim
A
A
Maguire
D
D
McCormick
P A
PA
Hegarty
J E
JE
Geoghegan
J G
JG
Traynor
O
O
D000328:Adult; D001663:Bilirubin / Q000097:blood; D005260:Female; D006501:Hepatic Encephalopathy / Q000145:classification / Q000401:mortality / Q000601:surgery; D006801:Humans; D019934:International Normalized Ratio; D017114:Liver Failure, Acute / Q000145:classification* / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists
D001663:Bilirubin