title: MELD score: utility and comparison with King's College criteria in non-acetaminophen acute liver failure.
abstract: OBJECTIVE
  To compare Model for End-stage Liver Disease Score (MELD Score, MS) and King's College Hospital (KCH) criteria for finding correlation of mortality in non-acetaminophen induced acute liver failure (NAI-ALF).
  
  
  METHODS
  An analytical cross-sectional study.
  
  
  METHODS
  The Aga Khan University Hospital, Karachi, from 2005 to 2007.
  
  
  METHODS
  The study included patients with NAI-ALF. KCH criteria were labelled as good and bad prognosis groups. MELD score were calculated by using the MELD calculator. ROC was plotted and sensitivity analysis was done. ETA was used to see correlation between MELD and KCH.
  
  
  RESULTS
  Ninety-one patients with mean age of 32.5 + 16.3 years were studied; 49 were males (54%). Out of these, 57 patients died (63%); two leading causes of non-acetaminophen induced acute liver failure (NAI-ALF) were hepatitis hepatitis B virus (HBV) (n = 30, 33%) followed by hepatitis E virus in (n = 23, 25.3%). According to King's College Hospital (KCH) criteria, 50 patients (88%) who died had bad prognosis and 24 patients (70.6%) who survived had good prognosis. The ROC determined MELD score of 32 was the best predictor of mortality with sensitivity and specificity of 79% and 71%, respectively and positive predictive value (PPV) and negative predictive values (NPV) of 82% and 67% respectively. There was significant association between mortality and bad prognosis according to KCH criteria (p < 0.001). Overall mean MELD score (MMS) was 35.35 + 8.64. MMS on admission was 38 + 7.32 in patients who died and 30.7 + 8.77 in those who survived (p = < 0.001). MMS correlated equally with KCH criteria (ETA = 0.52).
  
  
  CONCLUSIONS
  The admission MELD score has an excellent utility and correlates equally with KCH criteria for mortality in NAI- ALF.
authors.affiliation: Department of Medicine, The Aga Khan University Hospital, Stadium Road, Karachi. om.parkash@aku.edu
authors.forename: Om
authors.initials: O
authors.lastname: Parkash
authors.forename: Khalid
authors.initials: K
authors.lastname: Mumtaz
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.forename: Syed Hasnain
authors.initials: SH
authors.lastname: Ali Shah
authors.forename: S M
authors.initials: SM
authors.lastname: Wasim Jafri
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015415:Biomarkers / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007565:Jaundice / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D008297:Male; D008954:Models, Biological; D010154:Pakistan / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers