title: Selecting an optimal cutoff value for creatinine in the model for end-stage liver disease equation.
abstract: BACKGROUND
  The model for end-stage liver disease (MELD) is used for organ allocation in liver transplantation. The maximal serum creatinine (Cr) level for MELD is set at 4.0 mg/dL; however, there was no outcome data to justify this strategy.
  
  
  METHODS
  Ninety-two patients with cirrhosis with Cr level >4 mg/dL were selected from 1438 patients and compared with MELD score-matched controls for three-month and six-month mortality.
  
  
  RESULTS
  At three months, patients with Cr level >4 mg/dL had a significantly higher mortality rate than the 184 controls with a lower Cr level (44.6% vs. 29.3%, p = 0.015). This trend was still significant at six months: the mortality rate was 62% in the index group vs. 45.1% in the control group (p = 0.011). The difference between the index and control groups was the smallest (2.5% at three months and 3.4% at six months) when Cr was up-scaled to 5.5 mg/dL. The predictive accuracy of the MELD was estimated by using area under receiver-operating characteristic (AUC) curve. Only the cutoff of 5.5 mg/dL at six months displayed a higher AUC (0.753).
  
  
  CONCLUSIONS
  A cutoff at 5.5 mg/dL may be more appropriate for the MELD. The MELD for patients with cirrhosis with advanced renal insufficiency deserves re-evaluation.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. tihuo@vghtpe.gov.tw
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Lee
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000368:Aged; D019540:Area Under Curve; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement
chemical_list: D003404:Creatinine