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Influence of serum sodium on MELD-based survival prediction in alcoholic hepatitis
Brianna E Vaa1, Sumeet K Asrani, Winston Dunn
1Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA.
Objective:
To compare the Model for End-Stage Liver Disease (MELD) with the modified model including sodium (MELDNa) for predicting 180-day mortality in patients with alcoholic hepatitis (AH) and determine the subset in whom serum sodium may enhance 180-day mortality prediction.
Patients And Methods:
We examined 26 patients with AH enrolled in a prospective trial between June 1, 2004, and June 30, 2007, at Mayo Clinic. Logistic regression analysis was done to assess the effect of MELD and MELDNa scores on 180-day mortality. The C statistic was derived to compare MELD with MELDNa in patients with and without ascites.
Results:
MELD (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.05-1.47; P = .007; C statistic, 0.81) and MELDNa (OR, 1.24; 95% CI, 1.05-1.56; P = .008; C statistic, 0.78) were significant predictors of 180-day mortality in patients with AH. A MELD score of 27.0 and a MELDNa score of 28.0 had sensitivity of 76.5% and 87.5% and specificity of 64.9% and 52.5%, respectively. In patients with AH and ascites, MELDNa (OR, 2.27; 95% CI, 1.22-36.68; P = .008; C statistic, 0.97) was a better predictor of 180-day mortality than MELD (OR, 1.37; 95% CI, 1.07-2.12; P = .006; C statistic, 0.90). A MELD score of 29.0 and a MELDNa score of 34.0 had sensitivity of 85.7% and 83.3% and specificity of 31.0% and 16.7%, respectively.
Conclusion:
MELD and MELDNa were similar predictors of 180-day mortality; however, MELDNa was a better predictor of mortality than MELD in patients with ascites. Hyponatremia in patients with AH without ascites is not a predictor of mortality because it may have a dilutional basis secondary to excessive intake of low-osmolar alcohol.
Insights
The Model for End-Stage Liver Disease (MELD) and MELD including sodium (MELDNa) scores similarly predict mortality in alcoholic hepatitis (AH). MELDNa offers improved prediction for AH patients with ascites.
Area of Science:
- Hepatology
- Clinical Medicine
- Prognostic Biomarkers
Background:
- Alcoholic hepatitis (AH) is a severe liver condition with high mortality.
- Accurate prediction of mortality is crucial for managing AH patients.
- The Model for End-Stage Liver Disease (MELD) score is a common prognostic tool.
Purpose of the Study:
- To compare the predictive performance of MELD and MELD including sodium (MELDNa) for 180-day mortality in AH patients.
- To identify patient subsets where serum sodium levels enhance mortality prediction.
Main Methods:
- Prospective trial involving 26 AH patients.
- Logistic regression analysis to assess MELD and MELDNa scores' impact on 180-day mortality.
- C statistic used to compare MELD and MELDNa in patients with and without ascites.
Main Results:
- Both MELD and MELDNa were significant predictors of 180-day mortality in AH patients.
- MELDNa demonstrated superior prediction of 180-day mortality compared to MELD in AH patients with ascites.
- Hyponatremia in AH patients without ascites did not predict mortality.
Conclusions:
- MELD and MELDNa show comparable overall prediction of 180-day mortality in AH.
- MELDNa is a more effective predictor of mortality in AH patients with ascites.
- Serum sodium levels may not be a reliable mortality predictor in AH patients without ascites due to potential dilutional effects.
