Correlation and comparison of the model for end-stage liver disease, portal pressure, and serum sodium for outcome prediction in patients with liver cirrhosis.
BACKGROUND
The model for end-stage liver disease (MELD), hepatic venous pressure gradient (HVPG), and serum sodium (SNa) are important prognostic markers for patients with liver cirrhosis. The correlation among these markers and their predictive accuracy for survival are unclear.


METHODS
A total of 213 cirrhotic patients undergoing hemodynamic measurement were analyzed. The correlations between MELD score, SNa, and hemodynamic parameters were investigated.


RESULTS
There was a significant correlation between MELD and HVPG (r=0.255, P<0.001), between SNa and MELD (r=-0.483, P<0.001), and between HVPG and SNa (r=-0.213, P=0.002). Using mortality as the end-point, the area under receiver operating characteristic curve (AUC) for MELD was 0.789, compared with 0.659 for HVPG (P=0.165) and 0.860 for SNa (P=0.34) at 3 months; the difference between HVPG and SNa was significant (P=0.015). The AUC at 6 months was significantly higher for SNa and MELD compared with that of HVPG. Among 134 patients with low (<14) MELD scores, a high (>16 mm Hg) HVPG, and low SNa (<135 mEq/L) predicted early mortality. In the Cox multivariate model, MELD, HVPG, and Child-Turcotte-Pugh scores were consistently identified as independent poor prognostic predictors when they were treated either as dichotomous or continuous variables in the model.


CONCLUSIONS
MELD score is closely associated with HVPG and SNa in cirrhotic patients. HVPG is not superior to MELD score or SNa for short-term outcome prediction. High HVPG and low SNa may identify high-risk patients with low MELD scores. High MELD, HVPG, and Child-Turcotte-Pugh scores are independent predictors of poor long-term survival.
Faculty of Medicine, Institute of Pharmacology, School of Medicine, National Yang-Ming University, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Ying-Wen
YW
Wang
Teh-Ia
TI
Huo
Ying-Ying
YY
Yang
Ming-Chih
MC
Hou
Pui-Ching
PC
Lee
Han-Chieh
HC
Lin
Fa-Yauh
FY
Lee
Chin-Wen
CW
Chi
Shou-Dong
SD
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D017093:Liver Failure / Q000097:blood / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D017082:Portal Pressure; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome
D012964:Sodium