The first three authors (T-I.H., H-C.L., S.C.H.) contributed equally to this work.
Comparison of four model for end-stage liver disease–based prognostic systems for cirrhosis
Article first published online: 28 MAY 2008
Copyright © 2008 American Association for the Study of Liver Diseases
Volume 14, Issue 6, pages 837–844, June 2008
How to Cite
Huo, T.-I., Lin, H.-C., Huo, S. C., Lee, P.-C., Wu, J.-C., Lee, F.-Y., Hou, M.-C. and Lee, S.-D. (2008), Comparison of four model for end-stage liver disease–based prognostic systems for cirrhosis. Liver Transpl, 14: 837–844. doi: 10.1002/lt.21439
- Issue published online: 28 MAY 2008
- Article first published online: 28 MAY 2008
- Manuscript Accepted: 29 DEC 2007
- Manuscript Received: 9 OCT 2007
- National Science Council of Taiwan. Grant Number: 96-2314-B-010-023-MY2
- Taipei Veterans General Hospital (Taipei, Taiwan). Grant Number: V95C1-009
Serum sodium (Na) has been suggested for incorporation into the Model for End-Stage Liver Disease (MELD) to enhance its prognostic ability for patients with cirrhosis. Three Na-containing models—the Model for End-Stage Liver Disease with the incorporation of serum sodium (MELD-Na), the integrated Model for End-Stage Liver Disease (iMELD), and the Model for End-Stage Liver Disease to sodium (MESO) index—were independently proposed for this purpose. This study investigated the accuracy of these 4 MELD-based models for outcome prediction. The c-statistic equivalent to the area under the receiver operating characteristic curve (AUC), used to predict 3- and 6-month mortality, was calculated and compared in 825 patients with cirrhosis. The MELD score tended to be lower with increasing Na level. At 3 months of enrollment, the iMELD had the highest AUC (0.807) and was followed by the MELD-Na (0.801), MESO (0.784), and MELD (0.773); the difference between the MESO and MELD was statistically significant (P = 0.013). At 6 months, the iMELD still had the highest AUC (0.797) and was followed by the MELD-Na (0.778), MESO (0.747), and MELD (0.735); all comparisons showed significant differences between each other (all P < 0.01), with the exception of iMELD and MELD-Na (P = 0.18). With the most discriminative cutoffs, the specificity and negative predictive value were 70%-85% and 89%-97%, respectively, at 3 and 6 months for the 4 models. Patients with spontaneous bacterial peritonitis (SBP) consistently had significantly higher MELD-derived scores in all 4 models compared to patients without SBP (all P < 0.01). Patients with hepatic encephalopathy also had higher scores in all 4 models, although the statistical significance was established only for the iMELD (41.0 ± 11.5 versus 37.6 ± 9.1, P = 0.037). In conclusion, the incorporation of Na into the MELD may enhance prognostic accuracy. Both the iMELD and MELD-Na are better prognostic models for outcome prediction in patients with cirrhosis. Patients with SBP have a higher MELD-derived score. Future studies are warranted to define the optimal MELD-based prognostic model for cirrhosis. Liver Transpl, 2008. © 2008 AASLD.