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Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation.
BMC Gastroenterol. 2009 Sep 25; 9:72.BG

Abstract

BACKGROUND

Decompensated 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.

METHODS

Data 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.

RESULTS

In 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 >or=9 and a MELD score of >or=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).

CONCLUSION

The 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.

Authors+Show Affiliations

Department of Internal Medicine IV, University Hospital of Heidelberg, Heidelberg, Germany. daniel_gotthardt@med.uni-heidelberg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19778459

Citation

Gotthardt, Daniel, et al. "Limitations of the MELD Score in Predicting Mortality or Need for Removal From Waiting List in Patients Awaiting Liver Transplantation." BMC Gastroenterology, vol. 9, 2009, p. 72.
Gotthardt D, Weiss KH, Baumgärtner M, et al. Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation. BMC Gastroenterol. 2009;9:72.
Gotthardt, D., Weiss, K. H., Baumgärtner, M., Zahn, A., Stremmel, W., Schmidt, J., Bruckner, T., & Sauer, P. (2009). Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation. BMC Gastroenterology, 9, 72. https://doi.org/10.1186/1471-230X-9-72
Gotthardt D, et al. Limitations of the MELD Score in Predicting Mortality or Need for Removal From Waiting List in Patients Awaiting Liver Transplantation. BMC Gastroenterol. 2009 Sep 25;9:72. PubMed PMID: 19778459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation. AU - Gotthardt,Daniel, AU - Weiss,Karl Heinz, AU - Baumgärtner,Melanie, AU - Zahn,Alexandra, AU - Stremmel,Wolfgang, AU - Schmidt,Jan, AU - Bruckner,Thomas, AU - Sauer,Peter, Y1 - 2009/09/25/ PY - 2009/04/30/received PY - 2009/09/25/accepted PY - 2009/9/26/entrez PY - 2009/9/26/pubmed PY - 2009/12/16/medline SP - 72 EP - 72 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 9 N2 - BACKGROUND: Decompensated 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. METHODS: Data 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. RESULTS: In 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 >or=9 and a MELD score of >or=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). CONCLUSION: The 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. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/19778459/Limitations_of_the_MELD_score_in_predicting_mortality_or_need_for_removal_from_waiting_list_in_patients_awaiting_liver_transplantation_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-9-72 DB - PRIME DP - Unbound Medicine ER -