Despite the sickest patients taking priority for liver transplants, pre-transplant death remains common, and many early deaths occur despite initially low Model for End-stage Liver Disease (MELD) scores.
Researchers in Virginia, America studied 507 cirrhotic United States' veterans who had been referred for consideration of liver transplantation between 1997 and 2003, in order to identify additional predictors of early mortality.
Most of the patients were male (98%) and in 88% of the cases cirrhosis was found to be caused by hepatitis C and/or alcohol.
The researchers analyzed data for a total of 296 patients referred prior to February 27, 2002 (training group).
Any findings were then validated by further analysis of 211 patients referred subsequently (validation group).
61 patients from the training group, (21%), died within 180 days without transplantation. Their median initial MELD score was 21.
MELD score, persistent ascites, and low serum sodium (<135 meq/L) were found to be independent predictors of early mortality.
|Persistent ascites and low serum sodium identify patients with cirrhosis as having a high mortality risk despite low MELD scores|
Where patients had a MELD score of less than 21, the researchers found that only low serum sodium and persistent ascites were independent predictors of mortality.
For patients with MELD scores above 21, only MELD was independently predictive.
Analysis of the validation group then confirmed the prognostic significance of persistent ascites and low serum sodium for low MELD score patients.
Risk varied continuously with worsening hyponatremia.
The researchers found that modifying MELD, by including points for persistent ascites and low serum sodium, improved prediction of early pre-transplant mortality in low MELD score patients.
Dr Heuman concluded, "Persistent ascites and low serum sodium identify patients with cirrhosis as having a high mortality risk despite low MELD scores".
He commented that "Further prospective studies are required into ascites, hyponatremia, and other findings indicative of hemodynamic decompensation that may be prognostic indicators in patients awaiting liver transplantation".