Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis.
BACKGROUND
The models for end-stage liver disease (MELD) and serum sodium (SNa) are important prognostic markers in cirrhosis. A novel index, MELD to SNa ratio (MESO), was developed to amplify the opposing effect of MELD and SNa on outcome prediction.


METHODS
A total of 213 cirrhotic patients undergoing hepatic venous pressure gradient (HVPG) measurement were retrospectively analyzed.


RESULTS
The MESO index correlated with HVPG (r=0.258, P<0.001) and Child-Pugh score (rho=0.749, P<0.001). Using mortality as the end point, the area under receiver operating characteristic curve (AUC) was 0.860 for SNa, 0.795 for the MESO index and 0.789 for MELD (P values all >0.3) at 3 months. Among patients with Child-Pugh class A or B, the MESO index had a significantly higher AUC compared with MELD (0.80 vs. 0.766, P<0.001). A MESO index <1.6 identified 97% of patients who survived at 3 months and the predicted survival rate was 96.5%. In survival analysis, MESO index >1.6 independently predicted a higher mortality rate (relative risk: 3.32, P<0001) using the Cox model.


CONCLUSIONS
The MESO index, which takes into account the predictive power of both MELD and SNa, is a useful prognostic predictor for both short- and long-term survival in cirrhotic patients.
Huo
Teh-Ia
TI
Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Wang
Ying-Wen
YW
Yang
Ying-Ying
YY
Lin
Han-Chieh
HC
Lee
Pui-Ching
PC
Hou
Ming-Chih
MC
Lee
Fa-Yauh
FY
Lee
Shou-Dong
SD
D019540:Area Under Curve; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D017093:Liver Failure / Q000175:diagnosis* / Q000401:mortality; D008954:Models, Biological; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*; D015996:Survival Rate
D012964:Sodium