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Influence of Serum Sodium on MELD-Based Survival Prediction in Alcoholic Hepatitis


      To compare the Model for End-Stage Liver Disease (MELD) with the modified model including sodium (MELDNa) for predicting 180-day mortality in patients with alcoholic hepatitis (AH) and determine the subset in whom serum sodium may enhance 180-day mortality prediction.


      We examined 26 patients with AH enrolled in a prospective trial between June 1, 2004, and June 30, 2007, at Mayo Clinic. Logistic regression analysis was done to assess the effect of MELD and MELDNa scores on 180-day mortality. The C statistic was derived to compare MELD with MELDNa in patients with and without ascites.


      MELD (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.05-1.47; P=.007; C statistic, 0.81) and MELDNa (OR, 1.24; 95% CI, 1.05-1.56; P=.008; C statistic, 0.78) were significant predictors of 180-day mortality in patients with AH. A MELD score of 27.0 and a MELDNa score of 28.0 had sensitivity of 76.5% and 87.5% and specificity of 64.9% and 52.5%, respectively. In patients with AH and ascites, MELDNa (OR, 2.27; 95% CI, 1.22-36.68; P=.008; C statistic, 0.97) was a better predictor of 180-day mortality than MELD (OR, 1.37; 95% CI, 1.07-2.12; P=.006; C statistic, 0.90). A MELD score of 29.0 and a MELDNa score of 34.0 had sensitivity of 85.7% and 83.3% and specificity of 31.0% and 16.7%, respectively.


      MELD and MELDNa were similar predictors of 180-day mortality; however, MELDNa was a better predictor of mortality than MELD in patients with ascites. Hyponatremia in patients with AH without ascites is not a predictor of mortality because it may have a dilutional basis secondary to excessive intake of low-osmolar alcohol.
      AH (alcoholic hepatitis), ALD (alcoholic liver disease), CI (confidence interval), MELD (Model for End-Stage Liver Disease), Na (sodium), OR (odds ratio)
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        • Paula H
        • Asrani SK
        • Boetticher NC
        • Pedersen R
        • Shah VH
        • Kim WR
        Alcoholic liver disease-related mortality in the United States: 1980-2003.
        Am J Gastroenterol. 2010; 105: 1782-1787
        • Malinchoc M
        • Kamath P
        • Gordon FD
        • Peine CJ
        • Rank J
        • ter Borg PC
        A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts.
        Hepatology. 2000; 31: 864-871
        • Freeman Jr, RB
        • Wiesner RH
        • Harper A
        • et al.
        The new liver allocation system: moving toward evidence-based transplantation policy.
        Liver Transpl. 2002; 8: 851-858
        • Wiesner RH
        • McDiarmid SV
        • Kamath PS
        • et al.
        MELD and PELD: application of survival models to liver allocation.
        Liver Transpl. 2001; 7: 567-580
        • Kamath PS
        • Wiesner RH
        • Malinchoc M
        • et al.
        A model to predict survival in patients with end-stage liver disease.
        Hepatology. 2001; 33: 464-470
        • Dunn W
        • Jamil LH
        • Brown LS
        • et al.
        MELD accurately predicts mortality in patients with alcoholic hepatitis.
        Hepatology. 2005; 41: 353-358
        • Wiesner R
        • Edwards E
        • Freeman R
        • United Network for Organ Sharing Liver Disease Severity Score Committee
        • et al.
        Model for End-stage Liver Disease (MELD) and allocation of donor livers.
        Gastroenterology. 2003; 124: 91-96
        • Kim WR
        • Biggins SW
        • Kremers WK
        • et al.
        Hyponatremia and mortality among patients on the liver-transplant waiting list.
        N Engl J Med. 2008; 359: 1018-1026
        • Guy J
        • Somsouk M
        • Shiboski S
        • Kerlan R
        • Inadomi JM
        • Biggins SW
        New model for end stage liver disease improves prognostic capability after transjugular intrahepatic portosystemic shunt.
        Clin Gastroenterol Hepatol. 2009; 7: 1236-1240
        • Heuman DM
        • Abou-Assi SG
        • Habib A
        • et al.
        Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death.
        Hepatology. 2004; 40: 802-810
        • Biggins SW
        • Kim WR
        • Terrault NA
        • et al.
        Evidence-based incorporation of serum sodium concentration into MELD.
        Gastroenterology. 2006; 130: 1652-1660
        • Liamis GL
        • Milionis HJ
        • Rizos EC
        • Siamopoulos KC
        • Elisaf MS
        Mechanisms of hyponatraemia in alcohol patients.
        Alcohol Alcohol. 2000; 35: 612-616
        • Somsouk M
        • Guy J
        • Biggins SW
        • Vittinghoff E
        • Kohn MA
        • Inadomi JM
        Ascites improves upon [corrected] serum sodium plus [corrected] model for end-stage liver disease (MELD) for predicting mortality in patients with advanced liver disease.
        Aliment Pharmacol Ther. 2009; 30: 741-748
        • Boetticher NC
        • Peine CJ
        • Kwo P
        • et al.
        A randomized, double-blinded, placebo-controlled multicenter trial of etanercept in the treatment of alcoholic hepatitis.
        Gastroenterology. 2008; 135: 1953-1960
        • Carithers Jr, RL
        • Herlong HF
        • Diehl AM
        • et al.
        Methylprednisolone therapy in patients with severe alcoholic hepatitis: a randomized multicenter trial.
        Ann Intern Med. 1989; 110: 685-690
        • Akriviadis E
        • Botla R
        • Briggs W
        • Han S
        • Reynolds T
        • Shakil O
        Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial.
        Gastroenterology. 2000; 119: 1637-1648
        • Forrest EH
        • Evans CD
        • Stewart S
        • et al.
        Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score.
        Gut. 2005; 54: 1174-1179
        • Louvet A
        • Naveau S
        • Abdelnour M
        • et al.
        The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids.
        Hepatology. 2007; 45: 1348-1354
        • Gines P
        • Cardenas A
        • Arroyo V
        • Rodes J
        Management of cirrhosis and ascites.
        N Engl J Med. 2004; 350: 1646-1654
        • Mackle IJ
        • Swann DG
        • Cook B
        One year outcome of intensive care patients with decompensated alcoholic liver disease.
        Br J Anaesth. 2006; 97: 496-498
        • Pathak OK
        • Paudel R
        • Panta OB
        • Pant HP
        • Giri BR
        • Adhikari B
        Retrospective study of the clinical profile and prognostic indicators in patients of alcoholic liver disease admitted to a tertiary care teaching hospital in Western Nepal.
        Saudi J Gastroenterol. 2009; 15: 171-175
        • Gines P
        • Guevara M
        Hyponatremia in cirrhosis: pathogenesis, clinical significance, and management.
        Hepatology. 2008; 48: 1002-1010
        • Boyer TD
        Tolvaptan and hyponatremia in a patient with cirrhosis.
        Hepatology. 2010; 51: 699-702
        • Sheth M
        • Riggs M
        • Patel T
        Utility of the Mayo end-stage liver disease (MELD) score in assessing prognosis of patients with alcoholic hepatitis.
        BMC Gastroenterol. 2002; 2: 2
        • Lucey MR
        • Mathurin P
        • Morgan TR
        Alcoholic hepatitis.
        N Engl J Med. 2009; 360: 2758-2769