Addition of serum sodium to MELD score needed.

[Guest guest]

Dear All;

Here's another article just published in Liver Transplantation (2005)

11: 336-343; published online 17 Feb 2005) showing that including low

serum sodium in the MELD score gives a better prediction of waitlist

mortality. Recall that Shauna struggled desperately with low serum

sodium during her transplant wait. Let's hope that UNOS makes this

change to the MELD score SOON!!!!!!!

______________________

Addition of serum sodium into the MELD score predicts waiting list

mortality better than MELD alone

Andres E. Ruf 1 *§, Walter K. Kremers 2, Lila L. Chavez 1, Valeria I.

Descalzi 1, G. Podesta 1, Federico G. Villamil 1

1Liver Unit, Fundación Favaloro, Buenos Aires, Argentina

2 J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN

email: Andres E. Ruf (aruf@...)

*Correspondence to Andres E. Ruf, Liver Unit, Fundación Favaloro,

Avenida Belgrano 1782 (C1093AAS), Piso 5, Buenos Aires, Argentina

See Editorial on Page 261

Presented in part at the American Transplant Congress, Boston, MA,

May 14-19, 2004.

§Telephone: (54-11) 4378 1366; FAX: (54-11) 4378 1392

Funded by:

Foundation for Research and Education in Liver Diseases

National Institute of Diabetes and Digestive and Kidney Diseases;

Grant Number: DK34238

Abstract

In this study, we investigated the prognostic value of serum sodium

and hyponatremia (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 (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. 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.

______________________

Best regards,

Dave

(father of (19); PSC 07/03; UC 08/03)