Verification of usefulness of MELD-Na for predicting short term mortality in cirrhotics-Asian data

초록

Background/Aim: Model for end-stage liver disease with incorporation of serum sodium (MELD-Na) was suggested to provide better survival prediction than MELD alone for patients with end stage liver disease in Western countries. However, there is no data verifying the usefulness of MELD-Na for predicting short term mortality of cirrhotic patients in Asian countries where the etiology and the course of chronic liver diseases may be different. This study was aimed to determine whether MELD-Na would be more accurate in the prediction of short term mortality than other prognostic models such as Child-Turcotte-Pugh(CTP) and MELD in an Asian country as well. Methods: Medical records of patients with liver cirrhosis who admitted at Korea University Ansan Hospital between January, 1996 and September, 2006 were retrospectively reviewed. Patients with hepatocellular carcinoma, chronic renal failure, serious cardiopulmonary disease, sepsis or other malignant tumors were excluded. The cumulative survival rates according to the respective scores of three prognostic models at admission were decided with Kaplan-Meier presumed values, and the differences of survival were verified with log rank test. Predictability on mortality for three months and one year were analyzed using the area under receiver operating characteristics (AUC). Results: Data from 355 patients (male, 266; female, 89) were analyzed. Mean age was 55.9 years old. Major causes of liver cirrhosis were alcohol (177 patients, 49.9%), chronic HBV infection (142 patients, 40.0%), and chronic HCV infection (20 patients, 5.6%). Miscellaneous causes (16 patients, 4.5%) included autoimmune hepatitis, nonalcoholic fatty liver disease, and primary biliary cirrhosis. Mean follow up period was 18.9 months. One hundred patients (28%) died during the study period. All of the three models showed significant differences in the cumulative survival rate according to the scores at admission (p<0.001). The AUC of CTP, MELD, and MELD-Na in predicting the three-months mortality were 0.828, 0.845, and 0.862, (p>0.05) and the AUC of each score system for death within one year were 0.792, 0.800, and 0.831, respectively(p>0.05). The AUC of MELD-Na in predicting short term death was the highest, although not statistically significant. However,multivariate analysis showed that only MELD-Na was significantly related to three-month mortality among three prognostic models (p=0.012). Conclusion: It was shown that MELD-Na is more appropriate in predicting short term mortality, but larger scale studies are needed to confirm the superiority of MELD-Na to MELD or CTP in patients with liver cirrhosis.