With the implementation of the model for end-stage liver disease (MELD), refractory ascites, a known predictor of mortality in cirrhosis, was removed as a criterion for liver allocation.
Ascites is associated with low serum sodium.
Dr Terrault and colleagues from San Francisco, California evaluated serum sodium as an independent predictor of mortality in patients with cirrhosis who were listed for liver transplantation.
The researchers also studied whether the addition of serum sodium to MELD was superior to MELD alone.
The investigators designed a single-center retrospective cohort study of all adult patients with cirrhosis listed for transplantation from February 27, 2002, to December 26, 2003.
The research team included listing laboratories nearest the listing date ±2 months.
In total, the researchers found 513 patients that met inclusion criteria, and out of these, 341 were still listed, while 172 were removed from the list (105 for transplantation, 56 for death, 11 for other reasons).
| The risk of death with serum sodium < 126 mEq/L at listing or while listed was increased|
The researchers found that the median serum sodium and MELD scores were 137 mEq/L and 15, respectively, at listing.
The research team followed-up participants for a median of 201 days.
The researchers found that the risk of death with serum sodium < 126 mEq/L at listing or while listed was increased and the association was independent of MELD.
The research team calculated the c-statistics of receiver operating characteristic curves for predicting mortality at 3 months based upon listing MELD with and without listing serum sodium.
The team found that that c-statistics were 0.883 and 0.897, respectively, and at 6 months were 0.871 and 0.905, respectively.
Dr Terrault concluded, "Serum sodium < 126 mEq/L at listing or while listed for transplantation is a strong independent predictor of mortality."
"Addition of serum sodium to MELD increases the ability to predict 3- and 6-month mortality in patients with cirrhosis."