Selecting an optimal cutoff value for creatinine in the model for end-stage liver disease equation.
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.
Huo
Teh-Ia
TI
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. tihuo@vghtpe.gov.tw
Hsu
Chia-Yang
CY
Lin
Han-Chieh
HC
Lee
Pui-Ching
PC
Lee
Jing-Yi
JY
Lee
Fa-Yauh
FY
Hou
Ming-Chih
MC
Lee
Shou-Dong
SD
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
D003404:Creatinine