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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 B razil
Author(s) -
Marroni Caroline Possa,
Mello Brandão Ajácio Bandeira,
Hennigen Alexandre Wahl,
Marroni Claudio,
Zanotelli Maria Lúcia,
Cantisani Guido,
Fuchs Sandra Costa
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2012.01688.x
Subject(s) - medicine , gastroenterology , hazard ratio , model for end stage liver disease , receiver operating characteristic , liver transplantation , confidence interval , liver disease , cohort , area under the curve , transplantation , surgery
To compare the accuracy of standard model for end‐stage liver disease ( MELD ) score with that of four MELD ‐based scores incorporating serum sodium ( SN a) 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 SN a ( MELD ‐ Na , MELD ‐ Na 2), integrated MELD (i MELD ), and MELD to SN a 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 C ox 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 ( AUC s: MELD = 0.79 [95% CI = 0.72–0.87]; MELD ‐ Na = 0.84 [95% CI = 0.78–0.90]; MELD ‐ Na 2 = 0.85 [95% CI = 0.80–0.91]; i MELD = 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 ‐ Na 2 = 0.80 [95% CI = 0.74–0.85]; i MELD = 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 .