Your browser doesn't support javascript.
loading
Validation of the five-variable Model for End-stage Liver Disease (5vMELD) for prediction of mortality on the liver transplant waiting list.
Myers, Robert P; Tandon, Puneeta; Ney, Michael; Meeberg, Glenda; Faris, Peter; Shaheen, Abdel Aziz M; Aspinall, Alexander I; Burak, Kelly W.
Afiliação
  • Myers RP; Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Liver Int ; 34(8): 1176-83, 2014 Sep.
Article em En | MEDLINE | ID: mdl-24256642
ABSTRACT

BACKGROUND:

Modifications to the Model for End-Stage Liver Disease (MELD) have been proposed to improve prioritization of liver transplant (LT) candidates. Using a U.S. database, we derived a revised MELD including sodium and albumin [5-variable MELD (5vMELD)] that improved prediction of waiting list mortality. Our objectives were to confirm the association between hypoalbuminaemia and mortality and to externally validate 5vMELD in Canadian LT candidates.

METHODS:

Among adults registered on the LT waiting list at the University of Alberta (01/2000-10/2009), Cox regression determined the association between albumin and 1-year waiting list mortality. The discrimination of MELD, MELDNa and 5vMELD for predicting 1-year mortality were compared using c-statistics.

RESULTS:

Among 677 patients, 17% died and 51% underwent LT within 1 year of listing. Median serum albumin was 3.1 g/dl (IQR 2.6-3.6) and 70% of patients were hypoalbuminaemic (albumin <3.5 g/dl). One-year mortality in patients with normal serum albumin and hypoalbuminaemia were 14% and 29% respectively (P = 0.004). For patients with serum albumin between 2.0 and 4.0 g/dl, an approximately linear, inverse relationship was observed between albumin and 1-year mortality [adjusted hazard ratio (HR) 1.45; 95% CI 1.03-2.03; P = 0.03]. For this outcome, the c-statistic of 5vMELD (0.778) was superior to those of MELD (0.754) and MELDNa (0.765) (both P ≤ 0.05).

CONCLUSIONS:

Hypoalbuminaemia is an independent predictor of mortality on the LT waiting list. Compared with MELD and MELDNa, 5vMELD improves prediction of mortality suggesting that modification of these scores to include serum albumin should be considered as a means of prioritizing LT candidates.
Assuntos
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Listas de Espera / Técnicas de Apoio para a Decisão / Transplante de Fígado / Seleção de Pacientes / Doença Hepática Terminal Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Listas de Espera / Técnicas de Apoio para a Decisão / Transplante de Fígado / Seleção de Pacientes / Doença Hepática Terminal Tipo de estudo: Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2014 Tipo de documento: Article