Comparison of the model for end-stage liver disease (MELD), MELD-Na and MELDNa for outcome prediction in patients with acute decompensated hepatitis.

ABSTRACT

BACKGROUND AND AIM: The model for end-stage liver disease (MELD) is used to predict the outcome of patients with cirrhosis. Incorporation of serum sodium (Na) into MELD may further increase its prognostic ability. Two Na-containing MELD models, MELD-Na and MELDNa, were proposed to enhance the prognostic ability. This study compared the predictive accuracy of these models for acute decompensated hepatitis. METHODS: We investigated the outcome of 182 patients with acute decompensated hepatitis. RESULTS: Twenty (11%) patients died at 3 months. The MELD-Na and MELDNa both had significantly higher area under the receiver operating characteristic curve (AUC) in comparison to MELD (MELD-Na 0.908, MELDNa 0.895, MELD 0.823, p=0.004 and 0.001, respectively). Among 96 patients without specific antiviral treatment, the MELD-Na and MELDNa consistently had significantly higher AUC than the MELD (MELD-Na 0.901, MELDNa 0.882, MELD 0.810, p=0.008 and 0.004, respectively). Three independent indicators, pre-existing cirrhosis (odds ratio [OR] 5.67, 95% confidence interval [CI] 1.72-18.7), serum albumin<3.7 g/dL (OR 5.68, 95% CI 1.18-27.03) and serum sodium (Na)<138 mequiv./L (OR 10.0, 95% CI 2.08-47.62), were associated with 3-month mortality. CONCLUSION: MELD-Na and MELDNa provide better prognostic accuracy than the MELD for patients with acute decompensated hepatitis. The adequacy of liver reserve determines the outcome of these patients.