title: Influence of serum sodium on MELD-based survival prediction in alcoholic hepatitis.
abstract: OBJECTIVE
  To compare the Model for End-Stage Liver Disease (MELD) with the modified model including sodium (MELDNa) for predicting 180-day mortality in patients with alcoholic hepatitis (AH) and determine the subset in whom serum sodium may enhance 180-day mortality prediction.
  
  
  METHODS
  We examined 26 patients with AH enrolled in a prospective trial between June 1, 2004, and June 30, 2007, at Mayo Clinic. Logistic regression analysis was done to assess the effect of MELD and MELDNa scores on 180-day mortality. The C statistic was derived to compare MELD with MELDNa in patients with and without ascites.
  
  
  RESULTS
  MELD (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.05-1.47; P = .007; C statistic, 0.81) and MELDNa (OR, 1.24; 95% CI, 1.05-1.56; P = .008; C statistic, 0.78) were significant predictors of 180-day mortality in patients with AH. A MELD score of 27.0 and a MELDNa score of 28.0 had sensitivity of 76.5% and 87.5% and specificity of 64.9% and 52.5%, respectively. In patients with AH and ascites, MELDNa (OR, 2.27; 95% CI, 1.22-36.68; P = .008; C statistic, 0.97) was a better predictor of 180-day mortality than MELD (OR, 1.37; 95% CI, 1.07-2.12; P = .006; C statistic, 0.90). A MELD score of 29.0 and a MELDNa score of 34.0 had sensitivity of 85.7% and 83.3% and specificity of 31.0% and 16.7%, respectively.
  
  
  CONCLUSIONS
  MELD and MELDNa were similar predictors of 180-day mortality; however, MELDNa was a better predictor of mortality than MELD in patients with ascites. Hyponatremia in patients with AH without ascites is not a predictor of mortality because it may have a dilutional basis secondary to excessive intake of low-osmolar alcohol.
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Brianna E
authors.initials: BE
authors.lastname: Vaa
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Asrani
authors.forename: Winston
authors.initials: W
authors.lastname: Dunn
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.forename: Vijay H
authors.initials: VH
authors.lastname: Shah
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D000068800:Etanercept; D005260:Female; D006519:Hepatitis, Alcoholic / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D018709:Statistics, Nonparametric; D015996:Survival Rate
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D012964:Sodium; D000068800:Etanercept