Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantationReport as inadecuate




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BMC Gastroenterology

, 9:72

First Online: 25 September 2009Received: 30 April 2009Accepted: 25 September 2009

Abstract

BackgroundDecompensated cirrhosis is associated with a poor prognosis and liver transplantation provides the only curative treatment option with excellent long-term results. The relative shortage of organ donors renders the allocation algorithms of organs essential. The optimal strategy based on scoring systems and-or waiting time is still under debate.

MethodsData sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease MELD and Child-Turcotte-Pugh CTP scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores.

ResultsIn the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups p < 0.05, whereas serum creatinine and urea showed no difference.

Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of ≥9 and a MELD score of ≥14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores AUROC 0.73 and 0.68, resp.; p = 0.091.

ConclusionThe long term prediction of mortality or removal from waiting list in patients awaiting liver transplantation might be better assessed by the CTP score than the MELD score. This might have implications for the development of new improved scoring systems.

List of abbreviationsCTPChild-Turcotte-Pugh

LTxliver transplantation

MELDModel of End-Stage Liver Disease

TIPStransjugular intra-hepatic porto-systemic shunt.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-230X-9-72 contains supplementary material, which is available to authorized users.

Daniel Gotthardt, Karl Heinz Weiss contributed equally to this work.

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Author: Daniel Gotthardt - Karl Heinz Weiss - Melanie Baumgärtner - Alexandra Zahn - Wolfgang Stremmel - Jan Schmidt - Thomas Bru

Source: https://link.springer.com/



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