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Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone.
Ruf, Andres E; Kremers, Walter K; Chavez, Lila L; Descalzi, Valeria I; Podesta, Luis G; Villamil, Federico G.
Afiliação
  • Ruf AE; Liver Unit, Fundación Favaloro, Buenos Aires, Argentina. aruf@ffavaloro.org
Liver Transpl ; 11(3): 336-43, 2005 Mar.
Article em En | MEDLINE | ID: mdl-15719386
In this study, we investigated the prognostic value of serum sodium and hyponatremia (< or =130 mEq/L) in 262 cirrhotic patients consecutively listed, 19 of which died (7%), 175 survived (67%), and 68 underwent liver transplantation (26%) during 3 months of follow-up. Hyponatremia was present in 63% of patients who died, compared to 13% of those who survived (P < .001), whereas the proportion with elevated creatinine (> or =1.4 mg/dL) was low and similar in both groups (10.5 vs. 3%). Prevalence of hyponatremia was higher than that of elevated serum creatinine across all model for end-stage liver disease (MELD) categories. Using logistic regression, hyponatremia and serum sodium were significant predictors of mortality with concordance statistics (c-statistics) .753 for hyponatremia, .784 for sodium, .894 for MELD, .905 for MELD plus hyponatremia (P = .006 vs. MELD alone), and .908 for MELD plus serum sodium (P = .026 vs. MELD alone). Risk of death across all MELD scores was higher for patients with hyponatremia than without hyponatremia. Cox regression considering data within 6 months of follow-up yielded qualitatively similar results, with hyponatremia being a significant predictor of greater mortality risk with an odds ratio of 2.65 (P = .015). Each increase of 1 mEq/L of serum sodium level was associated with a decreased odds ratio of .95 (P = .048). Our results indicate that hyponatremia appears to be an earlier and more sensitive marker than serum creatinine to detect renal impairment and / or circulatory dysfunction in patients with advanced cirrhosis. In conclusion, addition of serum sodium to MELD identified a subgroup of patients with poor outcome in a more efficient way than MELD alone and significantly increased the efficacy of the score to predict waitlist mortality.
Assuntos
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Bases de dados: MEDLINE Assunto principal: Sódio / Listas de Espera / Transplante de Fígado / Cirrose Hepática Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Liver Transpl Assunto da revista: GASTROENTEROLOGIA / TRANSPLANTE Ano de publicação: 2005 Tipo de documento: Article País de afiliação: Argentina
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Bases de dados: MEDLINE Assunto principal: Sódio / Listas de Espera / Transplante de Fígado / Cirrose Hepática Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Liver Transpl Assunto da revista: GASTROENTEROLOGIA / TRANSPLANTE Ano de publicação: 2005 Tipo de documento: Article País de afiliação: Argentina