Limitation of MELD for ESLD for outcome prediction

October 17, 2006

Clin Transplant.

2006 Mar-Apr;20(2):188-94.

Limitation of the model for end-stage liver disease for

outcome prediction in patients with cirrhosis-related complications.

Huo TI, Lin HC, Wu JC, Hou MC, Lee FY, Lee PC, Chang FY, Lee SD.

National Yang-Ming University School of Medicine, Taipei, Taiwan.

The model for end-stage liver disease (MELD) has been used to prioritize

cirrhotic patients awaiting liver transplantation. Bleeding esophageal varices,

spontaneous bacterial peritonitis and hepatic encephalopathy are major

complications of cirrhosis and traditional indications for liver

transplantation evaluation. However, these complications are not included in

the MELD and it is not clear if these complications correlate with MELD score

in terms of outcome prediction. This study aimed to investigate the feasibility

of cirrhosis-related complication as a prognostic predictor in 290 cirrhotic

patients. The MELD score and outcome were compared between patients with and

without cirrhosis-related complications. There was no significant difference of

the MELD score between patients with (n = 67) and without (n = 223)

complications (11.6 +/- 2.9 vs. 12.2 +/- 3.2, p = 0.184). The area under the

receiver operating characteristic curve was 0.687 for MELD vs. 0.604 for

complications (p = 0.174) at six months, and the area was 0.641 for MELD vs.

0.611 for complications (p = 0.522) at 12 months. A high MELD score and

presence of complications had a similar profile of predictive accuracy and both

were significant predictors of mortality at six and 12 months in multivariate

logistic regression analysis. Patients with cirrhosis-related complications at

presentation had a decreased survival compared with those without complications

(p < 0.0001). In conclusion, the occurrence of cirrhosis-related

complications is a predictor of poor prognosis. While early transplantation

referral is recommended, these patients do not necessarily have a higher MELD

score and could be down-staged in the MELD era.

PMID: 16640525 [PubMed - indexed for MEDLINE]

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