Serum sodium based modification of the MELD score does not improve the predictive value in acute liver failure

Abstract

Aims: The MELD score, initially established to predict survival following TIPSS procedure has been utilized as a prognostic tool in ALF since 2007. Inclusion of serum Na+ into the MELD score was found to improve its predictive value in cirrhotic patients, as hyponatremia is associated with a worse prognosis. Aim of this study was to determine whether inclusion of serum Na+ improves the predictive value of MELD in ALF of diverse etiologies compared to established criteria. Methods: In a prospective single center study (11/2006–12/2010), 127 consecutive ALF patients were recruited. Clinical and laboratory data were collected upon admission. King’s College Criteria (KCC), MELD, MELD-Na and UKELD scores were calculated and AUROC calculations were performed for the prediction of spontaneous survival (SR) or non-spontaneous survival (NSA; death or transplantation). Results: ALF occurred due to drug intoxication (32%; 13% acetaminophen), acute HBV infection (14%), cardiac failure (15%), misc. (17%) and indeterminate ALF (19%). Outcome frequencies were 57% for SR, 19% for transplantation and 24% for death. A trend towards hyponatremia in deceased patients compared to SR was detected, although, Na+ failed to predict NSR in ALF (AUC: 0.548; CI: 0.434–0.662; p=0.168). Within the subgroup of patients with ALF secondary to cardiac failure, the predictive value for Na+ was better with an AUC of 0.758 (CI: 0.502–1.0; p=0.076). Overall performance of the classical MELD (AUC: 0.909; CI: 0.853–0.965; p<0.01) was superior to MELD-Na (AUC: 0.906; CI: 0.849–0.964; p<0.01), the UKELD (AUC: 0.729; CI: 0.628–0.830, p<0.01) and KCC. However, the serum Na+ levels alone were sufficient in predicting death vs. SR in this cohort (AUC: 0.651; CI: 0.51–0.793; p<0.05). Conclusion: In a cohort of ALF patients with various etiologies classic MELD performed superior to KCC in the prediction of NSR. Serum Na+ and Na-based modifications of the MELD did not further improve the prognostic value.