Comparison of four models for end-stage liver disease in evaluating the prognosis of cirrhosis.
OBJECTIVE
To investigate the prognostic value of the model for end-stage liver disease (MELD) and three new MELD-based models combination with serum sodium in decompensated cirrhosis patients-the MELD with the incorporation of serum sodium (MELD-Na), the integrated MELD (iMELD), and the MELD to sodium (MESO) index.


METHODS
A total of 166 patients with decompensated cirrhosis were enrolled into the study. MELD, MELD-Na, iMELD and MESO scores were calculated for each patient following the original formula on the first day of admission. All patients were followed up at least 1 year. The predictive prognosis related with the four models was determined by the area under the receiver operating characteristic curve (AUC) of the four parameters. Kaplan-Meier survival curves were made using the cut-offs identified by means of receiver operating characteristic (ROC).


RESULTS
Out of 166 patients, 38 patients with significantly higher MELD-Na (28.84 +/- 2.43 vs 14.72 +/- 0.60), iMELD (49.04 +/- 1.72 vs 35.52 +/- 0.67), MESO scores (1.59 +/- 0.82 vs 0.99 +/- 0.42) compared to the survivors died within 3 mo (P < 0.001). Of 166 patients, 75 with markedly higher MELD-Na (23.01 +/- 1.51 vs 13.78 +/- 0.69), iMELD (44.06 +/- 1.19 vs 34.12 +/- 0.69), MESO scores (1.37 +/- 0.70 vs 0.93 +/- 0.40) than the survivors died within 1 year (P < 0.001). At 3 mo of enrollment, the iMELD had the highest AUC (0.841), and was followed by the MELD-Na (0.766), MESO (0.723), all larger than MELD (0.773); At 1 year, the iMELD still had the highest AUC (0.783), the difference between the iMELD and MELD was statistically significant (P < 0.05). Survival curves showed that the three new models were all clearly discriminated the patients who survived or died in short-term as well as intermediate-term (P < 0.001).


CONCLUSIONS
Three new models, changed with serum sodium (MELD-Na, iMELD, MESO) can exactly predict the prognosis of patients with decompensated cirrhosis for short and intermediate period, and may enhance the prognostic accuracy of MELD. The iMELD is better prognostic model for outcome prediction in patients with decompensated cirrhosis.
Jiang
Ming
M
Department of Gastroenterology, Shanghai East Hospital Affiliated to Tongji University, 150 Jimo Road, Shanghai 200120, China.
Liu
Fei
F
Xiong
Wu-Jun
WJ
Zhong
Lan
L
Chen
Xi-Mei
XM
D018450:Disease Progression; D006305:Health Status Indicators; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D017093:Liver Failure / Q000097:blood / Q000209:etiology* / Q000401:mortality; D008954:Models, Biological; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D013997:Time Factors
D012964:Sodium