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Comparison of four models for end-stage liver disease in evaluating the prognosis of cirrhosis.

Abstract：

AIM:To investigate the prognostic value of the model for end-stage liver disease (MELD) and three new MELD-based models combination with serum sodium in decompensated cirrhosis patients-the MELD with the incorporation of serum sodium (MELD-Na), the integrated MELD (iMELD), and the MELD to sodium (MESO) index. METHODS:A total of 166 patients with decompensated cirrhosis were enrolled into the study. MELD, MELD-Na, iMELD and MESO scores were calculated for each patient following the original formula on the first day of admission. All patients were followed up at least 1 year. The predictive prognosis related with the four models was determined by the area under the receiver operating characteristic curve (AUC) of the four parameters. Kaplan-Meier survival curves were made using the cut-offs identified by means of receiver operating characteristic (ROC). RESULTS:Out of 166 patients, 38 patients with significantly higher MELD-Na (28.84 +/- 2.43 vs 14.72 +/- 0.60), iMELD (49.04 +/- 1.72 vs 35.52 +/- 0.67), MESO scores (1.59 +/- 0.82 vs 0.99 +/- 0.42) compared to the survivors died within 3 mo (P < 0.001). Of 166 patients, 75 with markedly higher MELD-Na (23.01 +/- 1.51 vs 13.78 +/- 0.69), iMELD (44.06 +/- 1.19 vs 34.12 +/- 0.69), MESO scores (1.37 +/- 0.70 vs 0.93 +/- 0.40) than the survivors died within 1 year (P < 0.001). At 3 mo of enrollment, the iMELD had the highest AUC (0.841), and was followed by the MELD-Na (0.766), MESO (0.723), all larger than MELD (0.773); At 1 year, the iMELD still had the highest AUC (0.783), the difference between the iMELD and MELD was statistically significant (P < 0.05). Survival curves showed that the three new models were all clearly discriminated the patients who survived or died in short-term as well as intermediate-term (P < 0.001). CONCLUSION:Three new models, changed with serum sodium (MELD-Na, iMELD, MESO) can exactly predict the prognosis of patients with decompensated cirrhosis for short and intermediate period, and may enhance the prognostic accuracy of MELD. The iMELD is better prognostic model for outcome prediction in patients with decompensated cirrhosis.

journal_name

World J Gastroenterol

journal_title

World journal of gastroenterology

authors

Jiang M,Liu F,Xiong WJ,Zhong L,Chen XM

doi

10.3748/wjg.14.6546

subject

Has Abstract

pub_date

2008-11-14 00:00:00

pages

6546-50

issue

eissn

1007-9327

issn

2219-2840

journal_volume

pub_type

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Comparison of four models for end-stage liver disease in evaluating the prognosis of cirrhosis.