title: MELD scores with incorporation of serum sodium and death prediction in cirrhotic patients on the waiting list for liver transplantation: a single center experience in southern Brazil.
abstract: To compare the accuracy of standard model for end-stage liver disease (MELD) score with that of four MELD-based scores incorporating serum sodium (SNa) to predict three- and six-month mortality in cirrhotic patients after their placement on the waiting list for liver transplantation (LT). A cohort study was performed. Receiver operating characteristic (ROC) curves were generated for MELD, MELD incorporating SNa (MELD-Na, MELD-Na2), integrated MELD (iMELD), and MELD to SNa ratio (MESO) index to assess the predictive accuracy of these scores to determine three- and six-month mortality. The c-statistic (area under the ROC curve [AUC]) was used to determine predictive power and the Cox proportional-hazard ratio to estimate death risk. We studied 558 patients. There was a statistically significant difference in the predictive accuracy of scores at three months (AUCs: MELD = 0.79 [95% CI = 0.72-0.87]; MELD-Na = 0.84 [95% CI = 0.78-0.90]; MELD-Na2 = 0.85 [95% CI = 0.80-0.91]; iMELD = 0.85 [95% CI = 0.80-0.90]; MESO = 0.81 [95% CI = 0.80-0.91]) and at six months (MELD = 0.73 [95% CI = 0.67-0.80]; MELD-Na = 0.79 [95% CI = 0.73-0.84]; MELD-Na2 = 0.80 [95% CI = 0.74-0.85]; iMELD = 0.80 [95% CI = 0.75-0.85]; MESO = 0.75 [95% CI = 0.69-0.81]) (p < 0.001). Death risk was independent of age and sex. Sodium-modified MELD scores are able to more accurately predict three- and six-month mortality among cirrhotic patients awaiting LT.
authors.affiliation: Post-Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Caroline Possa
authors.initials: CP
authors.lastname: Marroni
authors.forename: Ajácio Bandeira
authors.initials: AB
authors.lastname: de Mello Brandão
authors.forename: Alexandre Wahl
authors.initials: AW
authors.lastname: Hennigen
authors.forename: Claudio
authors.initials: C
authors.lastname: Marroni
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Zanotelli
authors.forename: Guido
authors.initials: G
authors.lastname: Cantisani
authors.forename: Sandra Costa
authors.initials: SC
authors.lastname: Fuchs
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001938:Brazil; D015331:Cohort Studies; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000401:mortality; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*; D015996:Survival Rate; D062606:Tertiary Care Centers; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult
chemical_list: D012964:Sodium