title: The Model for End-stage Liver Disease accurately predicts 90-day liver transplant wait-list mortality in Atlantic Canada.
abstract: OBJECTIVE
  To determine the generalizability of the predictions for 90-day mortality generated by Model for End-stage Liver Disease (MELD) and the serum sodium augmented MELD (MELDNa) to Atlantic Canadian adults with end-stage liver disease awaiting liver transplantation (LT).
  
  
  METHODS
  The predictive accuracy of the MELD and the MELDNa was evaluated by measurement of the discrimination and calibration of the respective models' estimates for the occurrence of 90-day mortality in a consecutive cohort of LT candidates accrued over a five-year period. Accuracy of discrimination was measured by the area under the ROC curves. Calibration accuracy was evaluated by comparing the observed and model-estimated incidences of 90-day wait-list failure for the total cohort and within quantiles of risk.
  
  
  RESULTS
  The area under the ROC curve for the MELD was 0.887 (95% CI 0.705 to 0.978) - consistent with very good accuracy of discrimination. The area under the ROC curve for the MELDNa was 0.848 (95% CI 0.681 to 0.965). The observed incidence of 90-day wait-list mortality in the validation cohort was 7.9%, which was not significantly different from the MELD estimate of 6.6% (95% CI 4.9% to 8.4%; P=0.177) or the MELDNa estimate of 5.8% (95% CI 3.5% to 8.0%; P=0.065). Global goodness-of-fit testing found no evidence of significant lack of fit for either model (Hosmer-Lemeshow c2 [df=3] for MELD 2.941, P=0.401; for MELDNa 2.895, P=0.414).
  
  
  CONCLUSIONS
  Both the MELD and the MELDNa accurately predicted the occurrence of 90-day wait-list mortality in the study cohort and, therefore, are generalizable to Atlantic Canadians with end-stage liver disease awaiting LT.
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. p.d.renfrew@dal.ca
authors.forename: Paul Douglas
authors.initials: PD
authors.lastname: Renfrew
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.forename: Christopher James
authors.initials: CJ
authors.lastname: Doig
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.forename: Michele
authors.initials: M
authors.lastname: Molinari
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D014850:Waiting Lists / Q000401:mortality*