Variation of the MELD score as a predictor of death on the waiting list for liver transplantation.
BACKGROUND
Currently, the most recent MELD score available for each waiting list patient is used to prioritize organs.


OBJECTIVE
The aim of our study was to identify the predictive value for death on a waiting list (WL) for the variation of MELD scores at specific time intervals.


METHODS
During 2004-2006, 208 consecutive adult patients were listed for liver transplantation in our Center. To identify the potential predictors of patient death, the univariate and multivariate Cox's proportional hazards regression model was used. To assess the ability of MELD score variation to correctly rank order patients according to risk of death while on the WL, c-statistic was used.


RESULTS
The 12 months actuarial survival was 81%. MELD score variation in the last three months was found as the only independent predictor of death on our WL (p=0.03). The c-statistics for prediction of death on the WL are 0.73 for MELD score at listing, 0.85 for MELD score at last evaluation, 0.62 for MELD variation from inclusion on WL, 0.86 for MELD variation within the last three months.


CONCLUSIONS
Dynamic evaluation of MELD scores with its recalculation within the last three months has the best predictive value for death on the WL.
Gheorghe
Liana
L
Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Str. Fundeni no. 258, 022328 Bucharest, Romania. drgheorghe@xnet.ro
Iacob
Speranta
S
Iacob
Razvan
R
Gheorghe
Cristian
C
Popescu
Irinel
I
D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000145:classification / Q000175:diagnosis / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D016019:Survival Analysis; D014850:Waiting Lists