The refit model for end-stage liver disease-Na is not a better predictor of mortality than the refit model for end-stage liver disease in patients with cirrhosis and ascites
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Background/Aims: The modification of the Model for End-Stage Liver Disease (MELD) scoring system (Refit MELD)and the modification of MELD-Na (Refit MELDNa), which optimized the MELD coefficients, were published in 2011. Weaimed to validate the superiority of the Refit MELDNa over the Refit MELD for the prediction of 3-month mortality inKorean patients with cirrhosis and ascites. Methods: We reviewed the medical records of patients admitted with hepatic cirrhosis and ascites to the KonkukUniversity Hospital between January 2006 and December 2011. The Refit MELD and Refit MELDNa were comparedusing the predictive value of the 3-month mortality, as assessed by the Child-Pugh score. Results: In total, 530 patients were enrolled, 87 of whom died within 3 months. Alcohol was the most commonetiology of their cirrhosis (n=271, 51.1%), and the most common cause of death was variceal bleeding (n=20, 23%). The areas under the receiver operating curve (AUROCs) for the Child-Pugh, Refit MELD, and Refit MELDNa scores were0.754, 0.791, and 0.764 respectively; the corresponding values when the analysis was performed only in patientswith persistent ascites (n=115) were 0.725, 0.804, and 0.796, respectively. The significant difference found among theChild-Pugh, Refit MELD, and Refit MELDNa scores was between the Child-Pugh score and Refit MELD in patients withpersistent ascites (P=0.039). Conclusions: Refit MELD and Refit MELDNa exhibited good predictability for 3-month mortality in patients withcirrhosis and ascites. However, Refit MELDNa was not found to be a better predictor than Refit MELD, despite theknown relationship between hyponatremia and mortality in cirrhotic patients with ascites.
Abstract
Background/Aims: The modification of the Model for End-Stage Liver Disease (MELD) scoring system (Refit MELD)and the modification of MELD-Na (Refit MELDNa), which optimized the MELD coefficients, were published in 2011. Weaimed to validate the superiority of the Refit MELDNa over the Refit MELD for the prediction of 3-month mortality inKorean patients with cirrhosis and ascites. Methods: We reviewed the medical records of patients admitted with hepatic cirrhosis and ascites to the KonkukUniversity Hospital between January 2006 and December 2011. The Refit MELD and Refit MELDNa were comparedusing the predictive value of the 3-month mortality, as assessed by the Child-Pugh score. Results: In total, 530 patients were enrolled, 87 of whom died within 3 months. Alcohol was the most commonetiology of their cirrhosis (n=271, 51.1%), and the most common cause of death was variceal bleeding (n=20, 23%). The areas under the receiver operating curve (AUROCs) for the Child-Pugh, Refit MELD, and Refit MELDNa scores were0.754, 0.791, and 0.764 respectively; the corresponding values when the analysis was performed only in patientswith persistent ascites (n=115) were 0.725, 0.804, and 0.796, respectively. The significant difference found among theChild-Pugh, Refit MELD, and Refit MELDNa scores was between the Child-Pugh score and Refit MELD in patients withpersistent ascites (P=0.039). Conclusions: Refit MELD and Refit MELDNa exhibited good predictability for 3-month mortality in patients withcirrhosis and ascites. However, Refit MELDNa was not found to be a better predictor than Refit MELD, despite theknown relationship between hyponatremia and mortality in cirrhotic patients with ascites.
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