Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis

Authors

  • Teh-Ia Huo,

    1. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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    • *Contributed equally to this work.

  • Ying-Wen Wang,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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    • *Contributed equally to this work.

  • Ying-Ying Yang,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Han-Chieh Lin,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Pui-Ching Lee,

    1. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Ming-Chih Hou,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Fa-Yauh Lee,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Shou-Dong Lee

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Correspondence
Han-Chieh Lin, MD, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.
Fax: +886 2 2873 9318
e-mail: hclin@vghtpe.gov.tw

Abstract

Background: The models for end-stage liver disease (MELD) and serum sodium (SNa) are important prognostic markers in cirrhosis. A novel index, MELD to SNa ratio (MESO), was developed to amplify the opposing effect of MELD and SNa on outcome prediction.

Methods: A total of 213 cirrhotic patients undergoing hepatic venous pressure gradient (HVPG) measurement were retrospectively analyzed.

Results: The MESO index correlated with HVPG (r=0.258, P<0.001) and Child–Pugh score (ρ=0.749, P<0.001). Using mortality as the end point, the area under receiver operating characteristic curve (AUC) was 0.860 for SNa, 0.795 for the MESO index and 0.789 for MELD (P values all >0.3) at 3 months. Among patients with Child–Pugh class A or B, the MESO index had a significantly higher AUC compared with MELD (0.80 vs. 0.766, P<0.001). A MESO index <1.6 identified 97% of patients who survived at 3 months and the predicted survival rate was 96.5%. In survival analysis, MESO index >1.6 independently predicted a higher mortality rate (relative risk: 3.32, P<0001) using the Cox model.

Conclusions: The MESO index, which takes into account the predictive power of both MELD and SNa, is a useful prognostic predictor for both short- and long-term survival in cirrhotic patients.

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