Ascites improves upon [corrected] serum sodium plus [corrected] model for end-stage liver disease (MELD) for predicting mortality in patients with advanced liver disease.
BACKGROUND
The clinical impact of ascites has historically been well recognized; however, its value is unclear in the context of current prognostic models.


OBJECTIVE
To determine whether ascites can improve risk discrimination beyond model for end-stage liver disease (MELD) and serum sodium (MELDNa).


METHODS
Consecutive cirrhotic patients were evaluated for ascites on the basis of an outpatient CT along with concurrent MELD and Na values. Cox models were used to determine the added value of ascites for predicting 1-year mortality. Increases in the C-index, integrated discrimination improvement (IDI) and the net reclassification index (NRI) were used to assess improvements in discrimination after the addition of ascites.


RESULTS
A total of 1003 patients had Na and MELD scores available within 30 days of the CT scan. A total of 60 deaths occurred within 1 year, with mortality higher in patients with ascites (21.4% vs. 4.0%, HR 6.08, 95% CI 3.62-10.19, P < 0.0005). In the presence of ascites, the MELD and MELDNa scores underestimated mortality risk when the scores were less than 21. The addition of ascites to the MELDNa model substantially improved discrimination by the C-index (0.804 vs. 0.770, increase of 3.4%, 95% CI 0.2-9.9%), IDI (1.8%, P = 0.016) and NRI (15.8%, P = 0.0006).


CONCLUSIONS
The incorporation of radiographic ascites significantly improves upon MELDNa for predicting 1-year mortality. The presence of ascites may help identify patients at increased risk for mortality, not otherwise captured by either MELD or MELDNa.
Somsouk
M
M
Division of Gastroenterology, Department of Medicine, San Francisco General Hospital, San Francisco, CA 94110, USA. somsoukma@medsfgh.ucsf.edu
Guy
J
J
Biggins
S W
SW
Vittinghoff
E
E
Kohn
M A
MA
Inadomi
J M
JM
D001201:Ascites / Q000150:complications* / Q000401:mortality; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality; D008297:Male; D011379:Prognosis; D012964:Sodium / Q000097:blood*
D012964:Sodium