title: Serum sodium based modification of the MELD does not improve prediction of outcome in acute liver failure.
abstract: BACKGROUND
  Acute liver failure (ALF) is a devastating clinical syndrome with a high mortality rate. The MELD score has been implied as a prognostic tool in ALF. Hyponatremia is associated with lethal outcome in ALF. Inclusion of serum sodium (Na) into the MELD score was found to improve its predictive value in cirrhotic patients. Therefore the aim of this study was to determine whether inclusion of serum Na improves the predictive value of MELD in ALF compared to established criteria.
  
  
  METHODS
  In a prospective single center study (11/2006-12/2010), we recruited 108 consecutive ALF patients (64% females / 36% males), who met the criteria defined by the "Acute Liver Failure Study Group Germany". Upon admission, clinical and laboratory data were collected, King's College Criteria (KCC), Model of End Stage Liver Disease score (MELD), and serum sodium based modifications like the MELD-Na score and the United Kingdom Model of End Stage Liver Disease score (UKELD) were calculated and area under the receiver operating characteristic curve analyses were performed regarding the prediction of spontaneous recovery (SR) or non-spontaneous recovery (NSR; death or transplantation).
  
  
  RESULTS
  Serum bilirubin was of no prognostic value in ALF, and Na also failed to predict NSR in ALF. The classical MELD score was superior to sodium-based modifications and KCC.
  
  
  CONCLUSIONS
  We validated the prognostic value of MELD-Na and UKELD in ALF. Classic MELD score calculations performed superior to KCC in the prediction of NSR. Serum Na and Na-based modifications of MELD did not further improve its prognostic value.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Hufelandstr 55, Essen, 45122, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Manka
authors.forename: Lars P
authors.initials: LP
authors.lastname: Bechmann
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Sowa
authors.forename: Martin
authors.initials: M
authors.lastname: Schlattjan
authors.forename: Julia
authors.initials: J
authors.lastname: Kälsch
authors.forename: Christoph
authors.initials: C
authors.lastname: Jochum
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
mesh_terms: D000328:Adult; D019540:Area Under Curve; D058625:End Stage Liver Disease / Q000097:blood* / Q000601:surgery; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012075:Remission, Spontaneous; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood*
chemical_list: D012964:Sodium
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