30Nov 2015

Value Of Different Models For End-Stage Liver Disease In Predicting Mortality In Cirrhotic Patients

  • Internal Medicine Department (Gastroenterology & Hepatology unit).
  • Community and Public Health Department Faculty Of Medicine, Zagazig University, Egypt.
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Serum sodium (Na) has been suggested for incorporation into the Model for End-Stage Liver Disease (MELD) to enhance its prognostic ability for patients with cirrhosis. Three Na-containing models (the Model for End-Stage Liver Disease with the incorporation of serum sodium (MELD-Na), the integrated Model for End-Stage Liver Disease (iMELD), and the Model for End-Stage Liver Disease to sodium (MESO) index) were independently proposed for this purpose. This study investigated the accuracy of these 3 MELD-based models for outcome prediction. Patients & Methods: Operational research was conducted on 151 patients with decompansated cirrhosis (child B & C). They were evaluated, and their medical and laboratory profiles were prospectively analyzed for one year. The outcome was assessed at the 3- and 6- and 12 month for complication and mortality. Results: We found that Na-based MELD scores had a better prognostic power than the standard MELD score in prediction of mortality in decompansated cirrhotic patients. The iMELD and MESO index gave the highest AUC (90%), sensitivity (97.4% & 94.5% respectively), NPV (98.8% & 96.9% respectively), and diagnostic accuracy (77.5% & 78.8% respectively). MELD score gave the highest specificity (79.5%) and PPV (75%). As regard association of major complications of cirrhosis and the MELD-based scores, there were statistical significance differences between cases had hepatic encephalopathy and refractory ascities and those hadn’t in all MELD scores. Regarding SBP the differences founded in MELD-Na and iMELD only. Finally no differences were found between cases had variceal bleeding and cases hadn’t in any of MELD scores except iMELD. Conclusion: the incorporation of Na into the MELD may enhance its prognostic accuracy, and both iMELD and MESO index are better prognostic models in prediction of outcome and complications in patients with decompensated cirrhosis.


[Sahar G. Zaghloul, Mohammad H. Ibrahim, Hussein M. Hussein, Amal A. El Badawy, Emad T. N. Mekhael (2015); Value Of Different Models For End-Stage Liver Disease In Predicting Mortality In Cirrhotic Patients Int. J. of Adv. Res. 3 (Nov). 1048-1059] (ISSN 2320-5407). www.journalijar.com


Emad T. N. Mekhael