Serum sodium based modification of the MELD does not improve prediction of outcome in acute liver failure

BMC Gastroenterology

Ali Canbay²  Guido Gerken²  Christian Trautwein³  Fuat H Saner¹  Andreas Paul¹  Christoph Jochum²  Julia Kälsch²  Martin Schlattjan²  Jan-Peter Sowa²  Frank Tacke³  Lars P Bechmann²  Paul Manka² 

[1] Department of General, Visceral and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany;Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Hufelandstr 55, Essen, 45122, Germany;Department of Medicine III (Gastroenterology and Metabolic Disorders), University Hospital Aachen, Aachen, Germany

关键词: Sodium;    UKELD;    MELD-Na;    MELD;    ALF;   

Others  :  858102
DOI  :  10.1186/1471-230X-13-58

 received in 2012-12-11, accepted in 2013-03-21,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Manka et al.; licensee BioMed Central Ltd.

【 图 表 】

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