The Refit model for end-stage liver disease-Na is not a better predictor of mortality than the Refit model for end-stage liver disease in patients with cirrhosis and ascites.
OBJECTIVE
The modification of the Model for End-Stage Liver Disease (MELD) scoring system (Refit MELD) and the modification of MELD-Na (Refit MELDNa), which optimized the MELD coefficients, were published in 2011. We aimed to validate the superiority of the Refit MELDNa over the Refit MELD for the prediction of 3-month mortality in Korean patients with cirrhosis and ascites.


METHODS
We reviewed the medical records of patients admitted with hepatic cirrhosis and ascites to the Konkuk University Hospital between January 2006 and December 2011. The Refit MELD and Refit MELDNa were compared using the predictive value of the 3-month mortality, as assessed by the Child-Pugh score.


RESULTS
In total, 530 patients were enrolled, 87 of whom died within 3 months. Alcohol was the most common etiology of their cirrhosis (n=271, 51.1%), and the most common cause of death was variceal bleeding (n=20, 23%). The areas under the receiver operating curve (AUROCs) for the Child-Pugh, Refit MELD, and Refit MELDNa scores were 0.754, 0.791, and 0.764 respectively; the corresponding values when the analysis was performed only in patients with persistent ascites (n=115) were 0.725, 0.804, and 0.796, respectively. The significant difference found among the Child-Pugh, Refit MELD, and Refit MELDNa scores was between the Child-Pugh score and Refit MELD in patients with persistent ascites (P=0.039).


CONCLUSIONS
Refit MELD and Refit MELDNa exhibited good predictability for 3-month mortality in patients with cirrhosis and ascites. However, Refit MELDNa was not found to be a better predictor than Refit MELD, despite the known relationship between hyponatremia and mortality in cirrhotic patients with ascites.
Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Jun Jae
JJ
Kim
Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Jeong Han
JH
Kim
Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Ja Kyung
JK
Koo
Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Yun Jung
YJ
Choi
Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Soon Young
SY
Ko
Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Won Hyeok
WH
Choe
Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
So Young
SY
Kwon
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D019540:Area Under Curve; D001201:Ascites; D058625:End Stage Liver Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
Ascites; Hyponatremia; Liver Cirrhosis; Mortality; Stage Liver Disease