Several studies have shown that among patients on the waiting list for liver transplantation, the serum sodium concentration is an important predictor of mortality, over and above the MELD score. 5,8,10-14 The serum sodium concentration, like the components of the MELD score, is readily available, objective, and reproducible this makes the serum sodium concentration a reasonable candidate for consideration in a model of liver allocation. For example, hyponatremia has been associated with the hepatorenal syndrome, 5-9 ascites, 6-10 and death from liver disease. In addition to the MELD score, the serum sodium concentration has been recognized as an important prognostic factor in patients with liver cirrhosis. 1-4 In the United States, the MELD score has been used in determining priorities for organ allocation in liver transplantation since 2002. The MELD score is based on the results of three readily available, objective, and reproducible laboratory tests: the total serum bilirubin concentration, the international normalized ratio (INR) for the prothrombin time, and the serum creatinine concentration. The allocation of grafts for liver transplantation from deceased donors in the United States is based on medical urgency, which is estimated according to the Model for End-Stage Liver Disease (MELD) score. This population-wide study shows that the MELD score and the serum sodium concentration are important predictors of survival among candidates for liver transplantation. Thus, assignment of priority according to the MELD score combined with the serum sodium concentration might have resulted in transplantation and prevented death. When applied to the data from 2006, when 477 patients died within 3 months after registration on the waiting list, the combination of the MELD score and the serum sodium concentration was considerably higher than the MELD score alone in 32 patients who died (7%). Furthermore, a significant interaction was found between the MELD score and the serum sodium concentration, indicating that the effect of the serum sodium concentration was greater in patients with a low MELD score. Both the MELD score and the serum sodium concentration were significantly associated with mortality (hazard ratio for death, 1.21 per MELD point and 1.05 per 1-unit decrease in the serum sodium concentration for values between 125 and 140 mmol per liter P<0.001 for both variables). In 2005, there were 6769 registrants, including 1781 who underwent liver transplantation and 422 who died within 90 days after registration on the waiting list. The MELD score (on a scale of 6 to 40, with higher values indicating more severe disease) is calculated on the basis of the serum bilirubin and creatinine concentrations and the international normalized ratio for the prothrombin time. ![]() The predictor variable was the Model for End-Stage Liver Disease (MELD) score with and without the addition of the serum sodium concentration. Using data derived from all adult candidates for primary liver transplantation who were registered with the Organ Procurement and Transplantation Network in 20, we developed and validated a multivariable survival model to predict mortality at 90 days after registration. Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death. ![]() The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. ![]() The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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