title: The sequential organ failure assessment (SOFA) score is prognostically superior to the model for end-stage liver disease (MELD) and MELD variants following paracetamol (acetaminophen) overdose.
abstract: BACKGROUND
  The prognostic value of the model for end-stage liver disease (MELD) and sodium-based MELD variants in predicting survival following paracetamol overdose remains unclear.
  
  
  OBJECTIVE
  To examine the prognostic accuracy of sodium-based MELD variants in paracetamol-induced acute liver injury compared with the sequential organ failure assessment (SOFA) score.
  
  
  METHODS
  Retrospective analysis of 138 single time point paracetamol overdoses admitted to a tertiary liver centre. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post-overdose, and the daily MELD, MELD-Na, MELDNa, MESO, iMELD, UKELD, updated MELD and SOFA scores were calculated.
  
  
  RESULTS
  Sixty-six (47.8%) patients developed hepatic encephalopathy, of whom 7 were transplanted and 21 died without liver transplantation. SOFA had a significantly greater area under the receiver operator characteristic for the prediction of spontaneous survival compared with MELD at both 72 (P = 0.024) and 96 (P = 0.017) h post-overdose. None of the sodium-based MELD variants improved the prognostic accuracy of MELD. A SOFA score >6 by 72 h or >7 by 96 h, post-overdose predicted death/transplantation with a negative predictive value of 96.9 (95% CI 90.2-99.4) and 98.8 (95% CI 93.6-99.9) respectively. SOFA and MELD had similar accuracy for predicting the development of hepatic encephalopathy (P = 0.493).
  
  
  CONCLUSIONS
  The SOFA score is superior to MELD in predicting spontaneous survival following paracetamol-induced acute liver injury. Modification of the MELD score to include serum sodium does not improve prognostic accuracy in this setting. SOFA may have potential as a quantitative triage marker following paracetamol overdose.
authors.affiliation: Scottish Liver Transplantation Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
authors.forename: D G N
authors.initials: DG
authors.lastname: Craig
authors.forename: T W D J
authors.initials: TW
authors.lastname: Reid
authors.forename: E C
authors.initials: EC
authors.lastname: Wright
authors.forename: K G
authors.initials: KG
authors.lastname: Martin
authors.forename: J S
authors.initials: JS
authors.lastname: Davidson
authors.forename: P C
authors.initials: PC
authors.lastname: Hayes
authors.forename: K J
authors.initials: KJ
authors.lastname: Simpson
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*; D005260:Female; D006304:Health Status; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D015415:Biomarkers; D000082:Acetaminophen