Document Detail


Comparison of four model for end-stage liver disease-based prognostic systems for cirrhosis.
MedLine Citation:
PMID:  18508377     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Teh-Ia Huo; Han-Chieh Lin; Samantha C Huo; Pui-Ching Lee; Jaw-Ching Wu; Fa-Yauh Lee; Ming-Chih Hou; Shou-Dong Lee
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  14     ISSN:  1527-6473     ISO Abbreviation:  Liver Transpl.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-09-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  United States    
Other Details:
Languages:  eng     Pagination:  837-44     Citation Subset:  IM    
Affiliation:
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. tihuo@vghtpe.gov.tw
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MeSH Terms
Descriptor/Qualifier:
Aged
Area Under Curve
Female
Gastroenterology / methods
Humans
Liver Cirrhosis / diagnosis*,  physiopathology
Liver Failure / diagnosis*,  physiopathology
Male
Middle Aged
Models, Biological
Predictive Value of Tests
Prognosis
Reproducibility of Results
Sodium / metabolism
Treatment Outcome
Chemical
Reg. No./Substance:
7440-23-5/Sodium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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