Evidence-Based Incorporation of Serum Sodium Concentration Into MELD

Scott W. Biggins, W. Ray Kim, Norah A. Terrault, Sammy Saab, Vijay Balan, Thomas Schiano, Joanne Benson, Terry Therneau, Walter Kremers, Russell Wiesner, Patrick Kamath, Goran Klintmalm

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Abstract

Background & Aims: Serum sodium (Na) concentrations have been suggested as a useful predictor of mortality in patients with end-stage liver disease awaiting liver transplantation. Methods: We evaluated methods to incorporate Na into model for end-stage liver disease (MELD), using a prospective, multicenter database specifically created for validation and refinement of MELD. Adult, primary liver transplant candidates with end-stage liver disease were enrolled. Results: Complete data were available in 753 patients, in whom the median MELD score was 10.8 and sodium was 137 mEq/L. Low Na (<130 mEq/L) was present in 8% of patients, of whom 90% had ascites. During the study period, 67 patients (9%) died, 243 (32%) underwent transplantation, 73 (10%) were withdrawn, and 370 were still waiting. MELD score and Na, at listing, were significant (both, P < .01) predictors of death within 6 months. After adjustment for MELD score and center, there was a linear increase in the risk of death as Na decreased between 135 and 120 mEq/L. A new score to incorporate Na into MELD was developed: "MELD-Na" = MELD + 1.59 (135 - Na) with maximum and minimum Na of 135 and 120 mEq/L, respectively. In this cohort, "MELD-Na" scores of 20, 30, and 40 were associated with 6%, 16%, and 37% of risk of death within 6 months of listing, respectively. If this new score were used to allocate grafts, it would affect 27% of the transplant recipients. Conclusions: We demonstrate an evidence-based method to incorporate Na into MELD, which provides more accurate survival prediction than MELD alone.

Original languageEnglish (US)
Pages (from-to)1652-1660
Number of pages9
JournalGastroenterology
Volume130
Issue number6
DOIs
StatePublished - Jun 2006

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ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Biggins, S. W., Kim, W. R., Terrault, N. A., Saab, S., Balan, V., Schiano, T., Benson, J., Therneau, T., Kremers, W., Wiesner, R., Kamath, P., & Klintmalm, G. (2006). Evidence-Based Incorporation of Serum Sodium Concentration Into MELD. Gastroenterology, 130(6), 1652-1660. https://doi.org/10.1053/j.gastro.2006.02.010